The Complete Dental Examination,

June 1, 1999
With so many insurance companies having their HMOs, PPOs, and other alphabet-soup combinations, no wonder there is so much confusion among dentists and patients when it comes to the true concept of a fair fee. We all have had the experience of a patient coming into the office after we have quoted a fee and telling us that he or she thinks our recommended treatment can be done cheaper elsewhere.

Part 3

When the `fee card` is played, honesty about your convictions works best.

Joseph J. Massad, DDS, and

William J. Davis, DDS, MS

What is a "fair fee"?

With so many insurance companies having their HMOs, PPOs, and other alphabet-soup combinations, no wonder there is so much confusion among dentists and patients when it comes to the true concept of a fair fee. We all have had the experience of a patient coming into the office after we have quoted a fee and telling us that he or she thinks our recommended treatment can be done cheaper elsewhere.

Of course, you feel you have quoted a fair fee. Even though the patient has not opted for the lesser fee as yet, the fact that he/she has questioned your fee indicates that this person is considering seeking treatment from someone else. The patient still may feel you are the right dentist, but believes that it is to his/her advantage to "play the fee card."

Before quoting the fee, you must take into consideration both the patient`s dental and psychological factors. Did you ask yourself:

- What can I do for this patient that will be different and better than what he/she has received in the past?

- What problems do I see in treating this patient?

- Are the patient`s expectations about comfort, function, health, and esthetics realistic?

- Can I see a successful outcome before treatment is started?

- How much heart muscle, gut lining, and hair am I willing to give up over this case?

What is the "average" fee?

When you get the opportunity to ask patients about their concerns related to the fee, you will find out that they have been talking with friends or the insurance coordinator at their place of business. These individuals probably told them what they think the average fee should be in your area. If this happens to you, it presents an opportunity to discuss the concept of average and fair fees with your patients.

What is an average fee? Our mentor, L.D. Pankey, used to say, "Average is the best of the worst and the worst of the best." He meant that any dentist who provides average dental care might have to cut corners to move down the scale from "excellence to average." If you`re an average dentist, you should be charging average fees.

However, if you feel that you do the very best you can for your patients and use only the finest supplies and laboratory support, and have paid the price by taking numerous hours of continuing education, you are providing better than average care. If you are providing excellent care, you should be paid appropriately for it.

"Doctor, what will this cost?" If, during the consultation appointment, a patient asks this dreaded question, you have not anticipated this always-intimidating question and assuredly you will lose the flow of your conversation. This is a very distracting interruption, which can throw you off balance. Many dentists become defensive and everything appears to be money-oriented to the patient, instead of quality-oriented. Do not let this happen to you! Anticipate this situation by addressing the cost issue at the beginning of your consultation.

Here is one example we use at the consultation appointment to avoid this situation: "Mrs. Patient, today I would like to go over with you our findings, suggested treatment options, and costs you should expect." We then discuss our findings, treatment options, and, lastly, the fees.

This gives us the opportunity to express ourselves fully before stating the cost. We maintain our flow of conversation and do not become defensive due to an interruption. How-ever, if you get caught and the patient asks this question, then respond by asking the pa-tient a question: "Is the fee a major concern for you?" It`s been our experience that the patient usually will say, "No. I was just wondering."

However, others will say, "Yes, I am very concerned about the fee because of ..." When there is a concern about the fee, you must deal with this concern before the patient leaves that appointment. Generally, we give the patient several options - going into a holding pattern if finances are a major concern at this time and then continuing treatment at a later date, doing the complete treatment plan as recommended, or just not doing anything. This gives the patient an "out" without embarrassment. If we put a patient in a holding pattern, we can maintain the status quo without regression. Once finances have improved, we can proceed with the ideal treatment plan.

No matter what the patient`s response is, you will learn more about the patient that will help your long-term relationship later. You now have the opportunity to teach your patient the true meaning of a fair fee vs. the insurance company?s definition. You might say, OIn our practice, we always quote what we consider to be fair fees.O Wait approximately 10 seconds to be sure the patient is listening and say, ODo you know what I mean when I say fair fee?O

Our definition of a fair fee is: OThe fee we must charge as your dentist that allows us to provide you with the finest dental care we can deliver and that you, the patient, will gladly pay with gratitude and appreciation.O This tells your patient that you do not consider yourself to be an average dentist. You might even reiterate to him the definition of average: OThe best of the worst and the worst of the best.O

Very few patients want average treatment for themselves or their families. By the time you have presented your fair fee, you need to be aware of any concerns, fears, or objections a patient may have regarding his/her overall treatment plan. If there are any questions in your own mind during the consultation appointment, you should ask your patient, ODo you have any concerns about our treatment plan or the cost we have outlined for you?O

Money is a touchy subject in our society and many people will turn their minds off immediately if money is a major issue. On the one hand, we all are taught that we should pay fairly when excellent service is provided for us. On the other hand, no dentist wants to project an image of greed or be rejected. Before presenting your fee, you must whole-heartedly believe that the fee is reasonable for the dentistry you are providing. Having this inner confidence will go a long way toward convincing the patient that the cost is justified.

Expensive treatment plans

Sometimes we feel uncomfortable presenting an expensive treatment plan, even though we know it is needed and the fee is fair. We realize the treatment will be very time-consuming and arduous. This may result from the intricate mechanics involved, because the patient has a difficult personality, or because he or she has some physical limitations making it more difficult to provide treatment. If you are experiencing guilt about an expensive treatment plan, think back to the last time you presented a fee and faced the dilemma of redoing the dental work possibly several times due to circumstances beyond your control. Did you resent the job or perhaps even the patient? Do you remember saying to yourself, OI will never let this happen to me again.O Well, OagainO is here now! If you have absolute unencumbered confidence in your fee to begin with, you automatically will prevent that moment of Oseller?s remorseO from developing. It will be much easier for you to hold fast to your fair fee.

You should never be so desperate that you are forced to do any dentistry that you cannot afford to walk away from if you see too many pitfalls. Ideally, when your dentistry is done, the patient should be delighted with your care, and both you and the patient should be happy with the fee. Anything less can lead to resentment. You must be able to foresee a mutually beneficial outcome. Do not provide dentistry to any patient who will not appreciate your expert care, skill, and judgment. We do not need money that badly!

Communicate costs to your patients with conviction and honesty. Ask your patients if the cost is a major concern for them before initiating care. We have found that the most successful patient care that we deliver is due, in part, to the fact that all financial considerations have been dealt with before we begin treatment. Both the patient and the patient?s family have discussed the cost and have a clear understanding of the fee.

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