Expanding financial options

May 1, 1999
One of the main obstacles to increasing case acceptance in dental practices is creating sufficient value for patients. As dentistry is beginning a radical shift toward more elective treatment and providing a wider variety of services, patients are using a different set of standards to determine whether certain types of treatment are appropriate. When patients are making decisions on elective or luxury dentistry, their entire value systems are different. People who typically would not think twice

Patients` payment options often determine their acceptance of treatment.

Roger P. Levin, DDS, MBA

One of the main obstacles to increasing case acceptance in dental practices is creating sufficient value for patients. As dentistry is beginning a radical shift toward more elective treatment and providing a wider variety of services, patients are using a different set of standards to determine whether certain types of treatment are appropriate. When patients are making decisions on elective or luxury dentistry, their entire value systems are different. People who typically would not think twice about paying for restoration of a decayed tooth or a crown on a fractured tooth seriously contemplate whether or not they should pay for cosmetic dentistry, implant dentistry, or other types of elective services.

Most patients make their decisions about elective treatment based on cost. In The Levin Group management-consulting programs, we teach case presentation and case acceptance. We explain that patients either want more information and are interested in treatment or they are not interested in pursuing the recommended treatment based on a series of decision points. These decision points include:

Discomfort - Many patients judge whether they want to have treatment based on discomfort alone. Explain pain control and the level of invasiveness of every procedure. Confronting the pain-control issue as a standard aspect of treatment-planning is tremendously beneficial in motivating patients to accept care.

Most of us have been taught never to use the word pain and we often avoid the subject. We also make an assumption that patients believe they will be comfortable while they are in our offices based on our beliefs that we can achieve that level of comfort. Unfortunately, many patients never express their concerns about pain, especially if they are embarrassed to admit their fears. Many times, the patients just don`t accept treatment.

Time - Time is becoming an increasingly important factor in patients` decision-making. People are so busy today that time has become one of their most important commodities. Although it may be difficult to believe, many patients will put off treatment simply because they do not think that they can allocate the time for the treatment process. While to us it may only be three, five, or seven appointments to accomplish a major goal for the patient, to them it is time that they are not willing to sacrifice.

Trust - Trust is one of the most important factors in successful treatment presentation. I have explained to many of our clients that for patients to trust you, they also have to like you. Patients who like you feel that they can trust you.

This often works in our favor. Most dentists are friendly and honest. Patients put tremendous confidence in those qualities. Fortunately, dentistry is such a high-ethics profession that consumer trust usually is satisfied. However, problems may arise when a patient does not trust a dentist.

This does not mean the dentist is not trustworthy. It does mean that the service or treatment being recommended does not have the value to the patient that the dentist believes it should. This often results in patients deciding not to go forward with treatment as they do not believe it is necessarily in their best interest.

Probably one of the best examples of this is the treatment of periodontal disease. Patients have difficulty understanding why they should have treatment if the disease does not hurt or is not visual.

Money - I tell our clients that it always comes down to money. If you are successful in moving through the above aspects of pain control, time, and trust, you still have one more hurdle. That hurdle is the cost of treatment and how patients will pay for it.

Be very careful not to be fooled. It does not matter, most of the time, whether the patient is middle-class or upper-class. The factor of money and how much the treatment will cost relates to the value of the service as perceived by the patient. Creating a sense of value for elective services is much more difficult. Many patients feel guilty about spending money on themselves that they could be spending on their families or saving for their futures.

Elective dentistry is a luxury service that must be "sold" to patients in the same way that they are sold other luxury services. The cost of treatment will be evaluated based on the value perceived.

Dealing with dollars

Discussing the cost and payment method for dental treatment is an area that every dentist should explore in great detail. Many offices simply come to the end of a treatment presentation, gloss over the fees, and have someone on the staff present a series of financial options.

At The Levin Group, we teach our clients that dentists should present the total case fee to a patient (although an excellent treatment coordinator can handle this) and that a team member, such as a financial coordinator, should present the financial options.

The best way to handle financial options is to understand that it is not how much treatment costs, but how patients will pay for it that often will determine their final decision. For example, how many people pay cash for their cars today vs. making the decision based on how much they can afford to pay per month? How many people pay cash for their houses vs. evaluating whether or not they can handle the monthly mortgage? Dentistry is no different - it is how patients pay for it and what arrangements they can make.

All clients in our consulting programs learn that they must have strict, standard financial options and prepared scripts to effectively present treatment fees to each patient. Failure to have scripts to explain treatment results in a variety of different explanation methods with varying results. Having optimal scripts allow you to confidently and consistently present financial options.

Varying from your standard financial options often causes problems for the practice. It is when you go out of your way and out of your standard systems to help patients that you end up in trouble. These are the patients who do not keep up with their payments based on the payment plan or find reasons to be completely dissatisfied with the treatment. Motivational psychology tells us that the value of something for which a patient has not paid diminishes as time goes on. Patients are most impressed and appreciative at the time they have treatment and not six months later.

Four standard financial options

Four standard financial options should be considered by every practice. They are:

(1) Offering 5 percent off for cash up- front - This is based on the concept that everybody is interested in saving money. Be sure to use a script that emphasizes positive aspects of saving money and how much the patient will save. (For more information, see "Management Scripts for Effective Communication with Patients," Levin Group, 1996). Many patients who are going to have treatment would rather pay cash upfront and save 5 percent.

(2) Accepting credit cards - If the patient cannot take advantage of the 5-percent-off option, offer the credit-card option. Visa, MasterCard, American Express, and Discover are the cards most patients use and should be a routine part of almost every practice. Many patients are comfortable using their credit cards for dental care because they use them for just about everything else. America is becoming dependent on credit-card usage, which is merely an electronic transfer of funds that allows the practice to receive payment in a timely manner. The small percentage that you will give up by accepting credit cards is insignificant compared to the positive benefits of a patient who has already paid and is focused on achieving the best result in cooperation with the practice.

(3) Paying half upfront, half by the end of treatment - For patients who cannot take advantage of the first two options, The Levin Group recommends that all patients pay half of the money upfront and the other half prior to the start of the final appointment. This sometimes results in confusion, as patients have to deal with their insurance co-payments.

The tactful script to use prior to the final appointment is:

"Mr. Jones, I know that you are going to be having your treatment completed today and will want to be on your way as quickly as you can when you finish. To make this convenient for you, why don`t we take care of your balance right now?"

In my experience, with few exceptions, the only patients who object to this "opportunity" are those who do not intend to pay you that day. At that point, you have to make a choice. Do you want to treat the patient and risk a collection problem? Or, do you want to reschedule the patient with an understanding that the balance must be taken care of before the final appointment?

As a side note, people often ask me about the issue of abandoning patients. Because it is illegal to abandon patients, you may have to provide the final treatment at some point. However, the issue of abandonment does not mean that you have to provide final treatment that day. Keep in mind that most patients are not aware of the issue of abandonment, and once they find out that they have to pay for the final appointment, they are very likely to return with check in hand. However, you should never violate the law.

One story I recently heard from a client involved a patient who claimed to have forgotten his wallet. When he found out that he would not be treated that day, he stated, "Let me check my car." Oddly enough, the wallet was in the car, he took care of the balance that day, and treatment was completed. Everybody won!

(4) Offering a Line of Credit - Because many Americans like to live well, many patients are not able to use any of the above three options. These patients would not be eligible for treatment, in most practices, because they would be unable to pay a reasonable portion of their treatment based on the previous three options. These patients often will end up without necessary treatment, and the practice ends up without production.

The solution to this problem - and one that we recommend to all clients - is to establish a line of credit that can be accessed by your patients who are credit-worthy. Many hardworking people who are unable to access significant amounts of cash on their own still are eligible for a line of credit to meet their dental needs.

The concept of the line of credit goes back to The Levin Group customer-service philosophy for all businesses that states, "make it easy for your customers to do business with you."

When a practice is able to offer a line of credit to patients who can be approved within about five minutes, many patients will qualify, practice production will rise, and more patients will have the opportunity to have optimal care.

Why offer credit?

In my high-profit dentistry seminars, I often address the issue of patient financial management. I tell the audience about a line of credit that can be accessed through a company called CareCredit. Not only have I been extremely impressed with CareCredit for a number of years, but it is endorsed by numerous state dental associations. I constantly ask members of the audience who use CareCredit if they are satisfied with the results of offering it to patients. I receive an overwhelming affirmative response.

In today`s dental practice, it is essential to help patients access a line of credit. Unlike a loan for which you have to apply every time you want to use money toward a certain service, the line of credit provides an ongoing source of funding for patients and their families.

Not only has CareCredit been extremely beneficial for all levels of restorative dentistry, but it also is outstanding for patients who seek high levels of cosmetic, implant, or reconstructive dentistry. Based on a quick-credit analysis, patients can qualify for significant funding to have the dentistry that they need or want .

What`s the catch? While I do not consider it a catch, CareCredit provides funds, interest-free, to patients for three, six, or 12 months while paying the practice in two days. The practice then will give up or lose a certain percentage of the total fee, which is retained by the finance company. Some professionals worry about discounting their fees by a percentage to pay for the line of credit. However, a very successful dentist once gave me great advice: "Don`t step over the dollars to pick up the pennies."

Because of the nature of dentistry and how carefully we watch our overhead, we often lose sight of the investment potential or opportunity when it comes to investing a few dollars. When I am discussing practice overhead in great detail, I always point out that there is overhead, such as OSHA, that provides no return on the investment. However, there is another type of overhead that I consider to be an investment in the practice. This overhead area includes new technology, staff training, continuing education, and providing a line of credit for patients.

The real secret to credit success

The real secret to using a line of credit is not simply to become a participant in a program. To me, that part is obvious and I encourage every dentist and client to offer a line of credit as the standard fourth option for patient financing.

The real secret of using a line of credit is not to hide it from patients unless there is no other option. Because a percentage is retained by the line-of-credit company, many practices try not to offer this option to patients except as a last-ditch effort. This rare use of a line-of-credit option has limitations because:

Y Office managers and financial coordinators will not be familiar enough with the product on a day-to-day basis to provide sufficient levels of motivation to your patients.

Y Many offices simply forget that they have the line-of-credit option to offer. In the meantime, many patients are rejecting treatment due to their inability to accept the first three financial options.

Y When a line of credit is under-endorsed by a practice that does have it available, it will not be presented in the most positive light by the financial coordinator. This may be due to a misunderstanding concerning the dentist`s lack of excitement about using the line-of-credit service.

Psychologically, staff members often will react to what they perceive to be the dentist`s point-of-view or desire and may even feel they will end up in some sort of trouble or in a bad light if they use a product the dentist does not find desirable. While we clearly are mixing the signals that we want to send, this is a reality that takes place in practices every day.

The secret of using a line-of-credit service is to use it daily. Make it a standard financial option. The increased production and revenue to the practice will be significant.


Offer all of your financial options, including the line of credit, and let the patient decide. Do not worry about whether or not the patient can handle the payment, whether or not the patient should have a line of credit, etc. As we tell all Levin Group clients, "Stop diagnosing the patient`s pocketbook." People in America pay for a myriad of different items that they may or may not be able to afford and should or should not purchase.

The better we utilize all four financial options, the more dentistry we will be providing to a larger and more satisfied population of patients. Make it easy for your patients to receive the treatment they need and want.