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Out-of-Pocket Collections: Mending the Holes by Kevin Tighe

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Header: Curious Curing
by Kevin Tighe

Getting patients to pay out of pocket for all—or a significant portion—of their treatment plan ultimately falls to the treatment coordinator, whose job (in part) is to help remove financial and scheduling barriers so patients rapidly complete their treatment.

A "dirty word," defined
  1. Income received for goods and services
  2. An act of completion of a commercial activity
  3. Operating revenues earned by a company
The above are three definitions of the word sales.

Most dentists and their staff would rather hear fingernails scratching a chalkboard than utter the words selling dentistry—in dentistry we call it "financial arrangements" or "case acceptance." Yet, it's vital that a treatment coordinator has some kind of sales DNA. Otherwise, you'll have more unscheduled treatment walking out the door than you can shake a stick at.

Why has it become so taboo to even mention the word selling in the dental industry? Mainly because the word sales has been associated with doing anything and everything to unjustly separate people from their hard-earned wages. But if your true intentions are to help patients overcome their fears and objections to receive the treatment you know they need, then you're on the right track.

The simple fact is, patients don't excitedly walk up to the front desk and proclaim, "I really love spending money on dentistry. Here's my credit card. Rack it up!" It takes the treatment coordinator to help get patients through their fears, worries and objections—and sales skills are a key part of doing that for any business, including yours. When you boil it down, selling has mostly to do with effectively educating the patient.

Educating patients
Whether done by the dentist or the treatment coordinator, the primary goal when presenting cases is to raise the dental IQ of the patient, resulting in one who places value on the treatment. That way the treatment coordinator will at least have a patient who'll try to figure out the finances. Whether the patient can work out the financial arrangements or not is another story, but you at least want a patient who actually understands what's going on in his or her mouth. Otherwise, the chances of patients rapidly moving forward with their full treatment plans are not good.

To consistently have a high percentage of cases accepted requires the skill to get patients to place value on their treatment. Here are several techniques and tips that help to effectively and efficiently increase a patient's dental IQ:

Analogies. The use of analogies is a fantastic educational tool that quickly allows you to get patients to understand what's going on in their mouths by comparing the condition to something they're already familiar with. For example, "A crack leaks. When a tooth leaks, you get decay. Kind of like a crack in your car window."

Here's another: "If you don't floss, then 33 percent of the tooth doesn't get cleaned. That's like taking a shower without washing from your stomach up."

There are a thousand different ways to describe dental conditions in terms your patients will immediately relate to. An excellent reference book is Dental Analogies by Dr. Rick Waters.

Words. Talk to patients in terms a layperson can easily understand. Don't assume patients know anything about their oral health. In general, they don't. Many times while listening to a dentist or treatment coordinator presenting treatment, I hear terms used that assume the patient just got back from an advanced course on altering occlusion function and aesthetics.

Show. Use patient education software or an intraoral camera, draw pictures, or show them models or their X-rays. You'll lose their interest if you don't. (But in doing so, don't forget the previous rule about using easily understandable terms.)

Questions. Don't ask the patient "Do you understand?"-type questions. Avoid questions that can be answered "yes" or "no." Too often, dentists and treatment coordinators just tell patients they need to do this, this and this in a rapid-fire style, throw terms like "leaky margins" around and then ask, "Do you understand?" The patient says yes, when of course he really doesn't. Most dentists and treatment coordinators never really get the patient to fully understand what needs to be done, or why. Statements such as, "Any questions?" or, "Do you understand?" makes it easier for the patient to leave without scheduling.

Talking. Dentists and treatment coordinators tend to talk too much. In fact, dentists and treatment coordinators often talk patients into—then out of—treatment. The more the patient is talking, the higher the case acceptance. This is accomplished by asking targeted questions such as, "What do you think will happen if you don't do anything about it?" "Which of those three treatments do you want to do?" Even more specific: "Did you know you were walking around with an infection 24 hours a day, seven days a week? How do you think that might affect your immune system?" Or, "Which way are you going on this chart if you don't do something to stop this process?"

Risk. Make sure patients understand what will likely happen to their oral and general health if they don't move forward. This is a key step.

Financial arrangements
The biggest problem I've run into when training treatment coordinators on financial arrangements is pretty simple: They don't listen to the patient.

Example 1: Patient says: "That's a lot of money. I can't imagine spending that much money on this." What treatment coordinator hears: "I can't afford it."

But "I can't afford it" isn't what the patient said! You have to read between the lines. What the patient is really communicating is that the dentistry isn't valuable to her. You have to teach staff to "tune their ear" and really listen to the patient.


Patient says: "How much of the treatment does my insurance cover?" What treatment coordinator hears: "I want to do only what my insurance covers."

So the treatment coordinator downgrades the treatment plan from four crowns to one.

Important note: Putting people who have personal financial problems on the job of treatment coordinator can have some pretty disastrous consequences on your collections. A person having a lot of trouble paying her own bills won't be able to do the job properly because she too easily goes into agreement with objections the patient may have.

Financial policy recommendations
Insurance:
  • Tell patients how much the insurance company is expected to pay.
  • Tell patients you'll bill the insurance company for that amount.
  • Inform patients they're responsible for that amount if the insurance company doesn't pay.
  • Collect the balance at the time of service.
  • If the insurance payment isn't received within at least 30 days, inform patients so they have a chance to contact the insurance company themselves.
  • If still no joy from the insurance company after 45 days, collect the balance from patients.
Fee-For-Service (FFS):
  • Prepay option: Five percent courtesy discount offered on treatment over $500. (Some offices offer this only to noninsurance patients. If you offer to insured patients, make sure to check with the insurance company for its specific rules.)
  • Twelve months same as cash, based on approved credit application: 0 percent interest if paid within a year. See CareCredit or another third-party finance company for information.
  • Payment at time of service: If need be, payment can be split over appointments if the treatment takes more than one visit. Only offer if they ask.
Long appointments and lab cases:
  • If an appointment is two or more hours, the procedure should be prepaid (minimally half down) in advance of the appointment. Explain that you have had patients not show up for these appointments in the past and the dentist and assistants sit around doing nothing for three hours. The doctor should sign off any exceptions to this rule.
  • For lab cases, the patient pays 50 percent up front.
Summary
Getting patients to pay out of pocket so they can rapidly complete all or a large portion of their treatment plans is the prime responsibility of the treatment coordinator. If a treatment coordinator approaches the job from a positive viewpoint, it can be one of the most rewarding positions in the dental office.

The hardest part of the treatment coordinator's job is discussing money. If the treatment coordinator is "sold" on the dentist, with a little sales DNA and effective training, he is home free.

The fun part is when patients profusely thank the treatment coordinator and all the other staff for convincing them to get the treatment done, because now that they have, they're so pleased with the difference it has made for them!

Whenever a treatment coordinator sits down in front of a patient to discuss money and treatment, it's important for her to remember that she is doing the patient a favor and is there to help. It can be a lot of fun. Enjoy it!



Kevin Tighe Kevin Tighe is the managing partner of Cambridge Dental Consultants. After his education at Boston University, Tighe spent the next decade working for several international nonprofits, where he refined his marketing skills and received mentoring from world-class business management experts, including several dental practice management gurus. He later joined Cambridge Dental Consultants, and after intense training on all things dental, crisscrossed the country for the better part of a decade delivering weekly practice management and marketing workshops. He subsequently became Cambridge's senior consultant and, eventually, managing partner. 



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