Love & Orthodontics
Love & Orthodontics
Dr Chris Baker is Past President of the American Orthodontic Society, a pediatric dentist and faculty member of three dental schools. She practices in Abu Dhabi, UAE, and Texas, USA. Dr Chris writes about orthodontics, pediatric dentistry and life.
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Yes! Accept Transfer Orthodontic Cases! (Most of the time.) Part II

Yes! Accept Transfer Orthodontic Cases! (Most of the time.) Part II

3/2/2017 4:06:00 AM   |   Comments: 0   |   Views: 44
You can have happy and loyal transfer patients!

In the UAE, because the expats come and go so often, we are accepting and sending many patients in transfer situations. And it works fine - even well.  You can do it too!

Earlier this month, I promised to tell you what to do when the mother and her daughter, a cute transfer patient, are sitting there, waiting for you to tell them about her transfer orthodontic treatment.

How can you take (most) transfer orthodontic patients and enjoy them? Part of the answer lies in how you charge them, so they don’t feel taken advantage of -- and so you don’t feel taken advantage of. And, how do you work with and communicate the unknown amount of treatment time left?

I've heard quotes like these from parents, “The other doctor told me we would need to ‘take off the braces, and start over,'” and “We just saw another dentist who said, ‘Whoever was doing your treatment didn’t know what they were doing.’”

There are NO benefits to tearing down the decisions the parent/patient has made in the past, in their choice of practitioners, in their lack of compliance, in "the other dentist’s work", etc.  That only serves to make the parent, patient and you feel bad.

And this approach makes you either look bad, OR, for a little while, like the “knight in shining armor.” (In time, the parent/patient may decide you are not this hero.  When a dentist tries the "knight in shining armor" approach and fails, things get even worse.)  

Better communications include statements like:
  • "Let me show you where your child is right now with her bite…"  Then, show the patient's occlusion, molar relationship, canine relationship, overbite, overjet, and other issues.
  • "My best 'guesstimate' is treatment for approximately (x) months, depending on how well she wears elastics, how long eruption of the ectopic tooth takes.., and then retainers."
  • "We may need to replace some brackets to provide the best results in my hands, and be the most time-efficient."  And/or, say, "There are two sizes of ‘slots’ in brackets. These brackets on her teeth are the ‘other’ size, so we will switch the brackets to the size we use, so that our wires and sequences work the best for your child."  
  • "Today I recommend records as to where she is now - photography of her teeth, (x-ray if needed, and models for measurement if needed.)  The cost for those records is ___."
  • "Your next visit will start with a review conference where you and I can review the treatment remaining, and the plan to accomplish it. Then, we will proceed to x-y-z (bracket revision, wire change, etc.)"
  • "The fees for her remaining treatment will be..." (Doctor, read and think about the following, and then you can project fees that the parent or adult patient will feel are ‘fair’ or ‘appropriate.’"

Here is a great approach for charging transfer patients:

A transfer patient is not an opportunity to take advantage of the parents and their money. Immediately charging a full case fee is not a good approach.

I have developed a fee structure that works well for the patients and for us. Remember parents have already paid a lot of money and are distressed when they are told that it will cost them a full case because you are "starting over." 

Here is my method:
Make an upfront charge to cover new records that you need, unless they come with very recent progress records. For example, if they have not had ceph tracings and other diagnostics you need, it is appropriate to give them a records fee that allows you to do just that.

If your diagnostic workup for that patient shows you do indeed need to replace all or many of the brackets, then you can have an upfront fee that covers that cost for the first visit. This means, when they start, they might pay as much as $1000 or $1500 for the ‘start-up’. Don't charge this if you don't need to replace brackets.

Following that, there is be a per month charge which includes any patient visits that month, whether 1, 2 or even 3 times. That monthly fee might be $350, or whatever is typical on your patient contracts, after your “down-payment” has been paid at bracketing. 

Again, our office charges it monthly, even if we need to see the patient more than once, to change power chain, etc. We charge only once for that month.  If we don't need to see a patient for 6-8 weeks, they pay for the month in which we see them.

This monthly fee will go on for as long as the treatment time requires. Then there is a removal and retainer delivery fee at the end, usually about $1000 to 1500 in our practice.

I have had patients who needed four or five months of finish up treatment, and I have had patients who needed a year and a half or more.

Also, I have had patients whose previous practitioner did not diagnose an ectopic tooth that was not a erupting, or an open bite that would need to be treated over a longer period of time, or with TAD’s etc. etc.

Most transfer patients need several months to a year or so of treatment. Many do need at least several brackets re-bracketed due to position changes that you need.  If it is minimal, we absorb that in the monthly fee, and just begin the monthly fee when we see them for the first treatment visit. 

However, if you use .022 wires and the transfer patient has an .018, or vice versa, you may wish to change the brackets. Again if that is needed, charge that initial fee to cover the removal and rebracketing.

Oh, and by the way, if the patient needs something at the transfer exam appointment, we ‘throw that in’ for, say, a module change or a pack of elastics.

Make sure your total fee for everything does not exceed your normal case fee that would be charged for that patient 

Often patients are happy to be more compliant because the parents understand that their fees will be based on how many months the patient needs to be in treatment.  

Sometimes patients come in with worsened appearances in their dentition or occlusion, due to the orthodontic care they have already received. I have had patients from several various countries come to our practice in the UAE with this situation. The first thing to do is take the wires out and let the teeth settle for about a month and see where everything is, then take your progress records and proceed.

© 2017 Dr Chris Baker
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