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Talking Fees without Feeling Queasy


How do you approach the fee question with patients? Do you give your patients a fee range or do you defer to the front desk? Do you see conversations about money as “cheapening” (pun intended) your role as a dentist or as part of your job?

I’ve been participating in an online discussion about this and I’m about to be tarred and feathered by an angry group of dentists who strongly disagree with me. They believe it’s not their job to talk about money with their patients. Several said that their mentors, from the 1980’s, advised them that physicians don’t talk money and to keep fee conversations and clinical conversations separate.

I think this perspective is bonkers.

Why this is Crazy

Let’s examine their position. They had successful mentors who advised them 40 years ago not to talk about money.  If we do some math, we can guess that these mentors had likely been practicing 30 years or more themselves. So, this means their advice about communicating with patients is generated from their experiences in the 1950’s. Wow! Do you think patients needs and expectations have changed since the 1950’s? From the 1950’s- 1980’s it’s likely dentists didn’t need to talk money because insurance would cover most of the expense. Obviously, economics have changed since then and so have patient’s expectations about what constitutes a good relationship with their dentist.

Your Objections

When I advise dentists that they need to be more involved in discussing fees, they get queasy. I want to be crystal clear: discussing fees doesn’t equate to making financial arrangements. I don’t advocate that you start calculating insurance or monthly payment options.

Let’s start by anticipating your objections to talking fees.  Does your thought bubble say?

  1. I don’t know my fees.
  2. I don’t want to get embroiled in long conversations about insurance or making financial arrangements.
  3. I’m uncomfortable talking about money.
  4. It’s silly to talk about fees with patients who only need fillings or who have benefits that will cover most of the cost.
  5. My team won’t let me talk money.

Why Talk Fees

There is one overarching reason you should give patients a fee range. It makes it more likely that patients will accept your treatment recommendations. If you have patients who nod and smile at you when they leave your operatory, but then leave without scheduling once they learn the fees at the front desk, then you need to rethink your stance about not talking fees.

Not talking fees with your patients creates a broken system with the following consequences:

  1. Shunting your patient off to the front desk means that your employees are “closing” your patients and you are out of the loop in responding to your patient’s concerns. If a patient balks at doing a large treatment plan, then your front desk team and the patient are making decisions about what to cut out or your front desk employee has to chase you down to learn what can be cut from a treatment plan to accommodate the patient’s financial concern. This is both awkward and time consuming.
  • Unless you have a dedicated treatment coordinator who uses a consult room, your front desk team are pulled in multiple directions and may not have sufficient time or training to work with a patient who has questions and concerns.  And it is not appropriate to discuss sensitive issues like finances in a reception area where other patients can overhear or the phones are ringing.
  • In addition, your front desk employees may not have the skill set to work with patients on an emotional level. Reviewing a patient’s benefits is not the same skill as connecting a patient’s motivators to recommended treatment.
  • Finally, the biggest reason why it’s a bad idea NOT discuss fees is, that for most patients, their objection to fees is not due to a lack of money but due to the value they place on the treatment itself.

How to Discuss Fees

Don’t begin a treatment dialogue talking fees but include it as a natural part of the conversation once you have made your recommendations.  Because investing money is symbolic of how we value a product or service, your approach is to help the patient recognize the value of treatment.

After you describe your treatment recommendations, ask this series of questions:

  • I see a great benefit in taking care of this now, but how do you feel about this? What do you see as the most important reason to have this treatment?
  • What would change in your life once you complete this treatment? 
  • The fee for this ranges from X to Y. How does this match what you were expecting?
  • Given everything we’ve talked about, what thoughts do you have about your next best step?  

These questions help the patient define the benefits of treatment for themselves with the fee presented as a natural part of this conversation.  Your role is to help the patient see the value of treatment because that is the crucial issue, not the dollar fee.  Now doesn’t that make more sense?

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“As an Office Manager, I’ve seen a great difference in my practice since starting with Sharyn. Three years ago our staff was in turmoil with a lot of infighting and gossip and some jealousy directed towards me.

I had given up because everything I did was judged. Now I have learned to have more one-to-one communication and by being more vulnerable with individuals I found my leadership voice. As a team, we’re all focused on the same goals.

Last year, in August we produced $88,000. This year we’re on track to produce $111,000 this month. I know it’s because we learned how to follow through with patients and communicate our expectations while building our systems.

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