When patients say “no”: How financial pathways drive trust, compliance, and case conversion

Almost every week, dental executives, clinicians, and practice teams tell me that they hear these objections to treatment plans prescribed:

“I can’t afford it right now.”
“Let me think about it.”
“I was declined for financing.”

My reply: “Did anyone have a one-on-one financial or budgetary conversation with the ‘I can’t afford it right now’ patients? It’s highly likely that the ‘let me think about it’ patients are too embarrassed to ask about payment options and the ‘I was declined for financing’ patients are an opportunity to pivot.”

The typical responses: “We didn’t know what to do, so we didn’t say anything.” Sometimes I’ll hear “We handed the patient a brochure,” or sometimes it’s “We told the patient to apply, but he or she was declined. We tried another lender, but they declined the patient too.”

The unfortunate outcome in every one of these cases was that another patient walked out the door, not because they didn’t want or need care, but because no one in the practice was confident and competent enough to have a one-on-one budgetary conversation with them. In a nutshell, no one helped the patient find a financial pathway forward to bridge the gap between the diagnosis and the decision to accept the care prescribed.

Big picture: this hurts more than just the practice and the patient. It hurts the entire health-care and dental ecosystem. We know that oral health is the gateway to overall well-being.

We need to acknowledge that we are in retail medicine today. Retailers know that they require payment options and various methods of payment for customers to buy. Dentistry is no different.

The cost of doing nothing

There are too many patients who need care for our industry to look the other way any longer.

According to a VideaHealth study conducted in 2023¹:

• 81% of patients hesitate before committing
• 31% of patients wait until pain becomes severe
• 53% of patients cite cost as the main barrier

For providers, those hesitations translate into unscheduled treatment, lost lifetime value, and patients returning only when problems have progressed.

The upside? The industry as a whole has become relatively proficient at marketing and progressing patients forward to schedule a visit; getting the patient in the door so the provider can diagnose the treatment needed.

The downside? After the treatment plan is defined, more often than not, the momentum stops. Why? Our industry has never really been trained to have a monetary conversation with a patient. I’m referring to an expert who knows how to appropriately, within regulatory compliance, have a one-on-one budgetary conversation with a patient. This includes understanding:

• the provider’s core treatment competencies
• basic credit principles
• insurance contribution
• loan products available (and the right loan product offer based on the treatment)
• how to document the conversation for the patient
• follow-up methodologies
• how to update the patient’s chart if there’s a lending dispute with the patient and the lender in the future.

Seeking an approval is only part of the equation.

When patients trust, trust converts, but trust must be supported by pathways that make care attainable with staff who are confident and adept in having a financial discussion with each patient independently.

Every patient is different; every diagnosis is different; every patient’s financial situation is different. A one-size-fits-all financial approach is unrealistic and will result in failure regardless of the economic climate.

For providers enrolled with one lender, that is a single point of failure. If the patient is declined or only approved for a nominal amount of the requested loan amount, the likelihood of them moving forward with care is minimal. Best practices allow your team to pivot to offer additional lending solutions that meet the patient’s budgetary needs and make the treatment financially viable.

Suggest a lending strategy

Providers often enroll in a patient lending program believing that they have a lending strategy.

A strategy is a well-thought-out plan that opens the door for the majority of your patient base to secure a payment option, should it be needed to create a pathway to move forward with the care prescribed. A well-defined lending strategy includes confident specialist team members who truly understand credit basics, lending, various loan products, regulatory compliance, and insurance reimbursement. Very few dental practices have this level of sophistication—the patient lending IQ in the health care and dental spaces is very low. As a result, regulators are stepping in.

Best practices suggest a lending strategy, per practice with a playbook designed for patient payment success. The playbook should be built based on the practice demographics and the treatment protocols offered. What happens in Burlington, Iowa, is quite different from Dallas, Texas. The patient demographics need to be considered when selecting lending partners and structuring your lending program.

Every decline is a door to reopen

A patient’s “no” often means “I don’t see how to make this work.” Teams who lead that next conversation—calmly, transparently, and compliantly—help patients move from uncertainty to action. Financing, viewed this way, becomes a strategy for access and continuity of care, not just a transaction.

Local lenders

If a patient isn’t approved through a third-party lender, that shouldn’t be the end of the discussion. In fact, it is an opportunity to build trust with the patient by helping him or her secure funding with a community bank or possibly a local credit union.

Local lenders:

• know their members personally
• can offer adaptable underwriting criteria
• recognize the value of supporting local health and dental companies in their communities.

A “no” from a third-party lender can become a “yes” when a provider or staff member helps connect the patient with regional financing options that see the whole picture.

The compliance reality

Establishing any lending relationship or referral process requires attention to federal and state consumer-finance laws. Providers should understand obligations under the Truth in Lending Act (TILA), the Equal Credit Opportunity Act (ECOA), and Unfair, Deceptive, or Abusive Acts or Practices (UDAAP), many of which are enforced by the Consumer Financial Protection Bureau (CFPB). Clear disclosures, documentation, and consistent communication protect both the practice and the patient.

When compliance is built into a lending playbook design, financing conversations become transparent and trustworthy rather than uncomfortable or risky. While regulatory oversight can feel overwhelming, it does not need to be if lending practices are set up correctly and staff are trained to have the money conversation ethically and within regulatory frameworks.

Building an ethical workflow

Practices that navigate patient financing correctly focus on three key areas:

Area 1: Redefining the conversation. Replace scripted sales talk with education and empathy. Patients need clarity, not pressure. In fact, stay away from “selling” altogether. Teams should be solving, never selling.

Area 2: Creating a documented process—a lending strategy. Create a lending playbook that illustrates how and when financing will be presented, what follow-ups will occur, how to pivot to another lending option should a decline happen, and who will manage the communication with external lenders.

Area 3: Training for consistency. Financial confidence is a skill set. It is not for everyone. Those having the money conversation need to understand both the language of reassurance, the terms and conditions of the documents that a patient is executing, and the limits of what they can say, and what is off limits.

When staff feel equipped and informed, utilization improves, case conversion rises, industry suppliers realize increased product opportunities, lenders continue to lend, hopefully regulatory pressure diminishes, and most importantly, trust deepens. When patients trust, trust converts. Everyone wins.

A practical framework for larger cases

Always work with third-party lenders in the industry first. Make sure you are offering the right loan product for the treatment. For larger cases, the installment loan is ideal.

Think of lenders as investors in the industry; every time they say “Yes, you’re approved” to a patient, they are making an investment in your practice. Furthermore, they are familiar with the treatment protocols offered in the space. Be mindful, there are a host of reasons why a patient is declined. Expecting one lender to approve the majority of your patient base is unrealistic and unfair.

In preparation for a decline (because it is inevitable):

Step 1: Identify local partners. Reach out to nearby credit unions or local banks to establish a relationship. Explain the unmet need among creditworthy patients. Many institutions will welcome collaboration.

Step 2: Map the workflow. Design a clear process with various third-party lenders predicated on your treatment protocols and patient demographics including all documentation, consent, referral, and necessary follow-up. Maintain compliance at all times. Consistency ensures compliance. Consult counsel to make sure that you are following both federal and state regulations.

Step 3: Educate the team. Teach staff to listen for hesitation cues, use transparent language, and maintain empathy. A confident, compliant team can turn declines into opportunities without pressure, not selling.

An industry shift toward lending literacy

For years, practices relied on one financing partner and accepted whatever approval rates resulted. Today, that one-size-fits-all model is giving way to lending literacy, an approach where providers understand financing principles as part of the continuity of patient care. This literacy doesn’t require becoming a lender; it means being informed enough to guide patients ethically through their options and protect everyone involved.

Lead the new conversation

Rising costs, limited insurance coverage, and increased patient hesitation make one truth clear: Providers and their teams who master the money conversation will define the next generation of care delivery.

Don’t take “no” for an answer. Take it as an invitation to lead, to create access, build trust, and ensure that financial barriers never stand between diagnosis and decision.

Author’s note: This article is provided for educational purposes only and does not constitute legal or regulatory advice. Regulations governing patient financing vary by state, including additional requirements in New York, Illinois, and California. Providers should consult legal counsel or compliance professionals familiar with their jurisdiction before implementing any financing program.

Editor's note: This article appeared in the January 2026 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

Reference

1. Poll: More than 90% of Americans know dental disease can increase potential risk for disease, and yet nearly 1 out of 2 have declined or delayed treatment. Business Wire. December 11, 2023. Accessed October 29, 2025. https://www.businesswire.com/news/home/20231211171536/en/Poll-More-than-90-of-Americans-Know-Dental-Disease-Can-Increase-Potential-Risk-for-Disease-and-Yet-nearly-1-out-of-2-Have-Declined-or-Delayed-Treatment