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Money and how to deal with it
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SOP
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4 options for payment
Michelle Strange: A Tale of Two Hygienists presents this week’s TIPisode: quick and easy tips to keep you up to date and presented by the experts in the profession. Now, get ready for your unofficial TIPisode.
Teresa Duncan: Hi. This is Teresa Duncan of Odyssey Management and also the host of the Nobody Told Me That! podcast and the co-host of the new Chew on This podcast. They can both be found on the Dental Podcast Network.
I’ve talked to you about insurance and finances in previous TIPisodes, and I’ve been receiving lots of questions about insurance but also a fair number of questions about actually presenting financial options and collecting payments from the patient. So I wanted to take a minute to talk to you about how to handle the subject of money.
Now, I know that most of you are clinical and that’s your world and dealing with finances is what happens up in the admin side of the practice, but I’m willing to bet that some of you do handle money in your practice. There’s nothing wrong with that. It just can be a little bit hairy in the beginning if you’re not sure what you’re talking about. So I wanted to give you what normally happens in an office that is handling money for the person who is handling money.
Well, we have to assess the financial health of the patient when they come in, and that’s not easy to do because, you know, we’re human. We like to look at somebody and assume that we sort of know their story, but we really don’t. Some of the best patients I’ve ever had came in wearing not great clothes. But you know what? Sometimes they’re eccentric, and they don’t like to show that. So what I’m saying is you can’t judge a book by its cover just like you can’t judge a person on whether or not they’re going to have perio disease from across the room. So, just like you do the diagnosis, we also have to discuss this type of thing with the patient. And, also, we must be just as blunt as some of you have to be.
So I’ll give you an example: I have to — say it’s a $3,000 treatment plan. Let’s just go with that number. I have to be very comfortable saying, “How would you like to take care of that $3,000 balance?” Now, if that has never come out of your mouth, if you’ve never said words with numbers that big or even bigger, it’s going to be a very awkward conversation.
I remember back in the day when I was doing treatment plan presentations for the first time, I was fine with that. You know, I could talk about clinical stuff. I had come from the assistant side, and I understood some of the clinical highlights. But I had never talked to anybody about money before, and money is just a totally different topic because, in reality, when you are asking somebody for money, you can’t help but place yourself into that position. And that is one of the issues that we come across, and I’ll save that for another topic. We do tend to sympathize with the patient, especially financial. We need to get over that. But, again, that’s going to be for another topic.
So don’t be afraid to broach the subject of money because guess what? Your patient is sitting there knowing that you’re going to talk about money, anticipating it, and if you don’t talk about it, they leave with bigger questions than they did when they were sitting in the chair.
Okay. So I know some of you are thinking, “Thank God I don’t have to deal with money,” and that’s fine. But it might be that somebody is missing in the office for one day, and you’re going to have to talk about it. I will tell you that the more you talk about $3,000, $5,000, $7,000, it gets a lot easier. So there’s some comfort in that.
And, what I wanted to do is give you the four options that are typical coming from the admin side. So — and this is something that your office should have on the books. They should know — everybody in your office should know what the standard protocol is when they go to offer financing or take appointments or take payments. This should all be in what we call “standard operating procedures.” Now, you guys have clinical guidelines; the admin side has standard administrative operating procedures. I hope that these are written down just because it’s easier to train new people coming on board when you do have this written down and something that’s easily referenced.
The reason why I want everybody to be on the same side — or I’m sorry, on the same page with this is that it’s much easier to say to the patient, “Well, this is how we typically handle this. I’m sorry, this is something that we’ve agreed to as an office. We must go by these guidelines.” For example, when you’re talking about offering credit and whether or not you are going to take credit — again, I’m getting off subject. Let me get back to what I was talking about here.
As far as the four options, there is always the full payment option. So, when I present financial options, I don’t assume that they’re going to need to make payments. I don’t assume that they’re thinking about doing it monthly. In all likelihood, that is what they’re doing. Most people don’t have thousands of dollars to put down right there at the appointment when I’m talking to them initially. However, I’m not going to rule that out.
Many times, patients have dental savings accounts, health savings accounts, flexible spending accounts through their jobs where they’re able to access that money and pay in full. There’s also people who are obviously independently wealthy. There’s people who firmly believe that health care is more important than taking a cruise. So you never know who you’re going to run into in the chair.
I always say to the patient — say it’s $3,000 again — “Mrs. Jones, it looks like your cost of care is going to be $3,000 when all is said and done with insurance.” Or your best estimate. And the patient will just look at me, and I’ll say, “How did you want to take care of that?” I’m not going to say, “Did you want to pay that?” Or “Do you think you want to pay that?”
And, believe me, it’s easy to do that because you’re in a position of wanting to make things as easy as possible for the patient. I get it. That’s what we’re there for. But this is not something I’m going to offer to them unless, eh, I’m not really sure what I’m doing. When you get better and better at this, you’ll realize these four options are all you have available to you, and that makes your job a lot easier.
Okay. So option number one, full payment. Hopefully, they go with that, and you don’t have to go down the line. The next one is does your office — and you have to answer this first — does your office have a policy where they offer a five percent or ten percent courtesy — not discount. I don’t like the word discount — but a courtesy to the patient if they were able to pay in full?
“Mrs. Jones, I understand that this is a large amount. It sounds like that’s not going to work for you. What I wanted to tell you is that for patients who are able to pay the amount in full, I am authorized to give you a five percent courtesy.” Or ten percent courtesy. “Doctor likes to do that because we know how important it is to save money.” Especially nowadays — right? — with the pandemic. And that’s my little side note. Don’t say that. But I do give them the verbiage of “You know what? If you can do that, I could do this for you.”
And this happens — people take me up on this not as often as they do just giving the full payment or the next option, which is third-party financing. So, again, let me just refresh: full payment offer. If they don’t bite on that, then it’s full payment if we can offer you a courtesy.
Okay. Third option is third-party financing. Now, this episode is not sponsored by CareCredit, but I am a huge CareCredit fan. I just have seen how well they treat their offices, and they really care about the training. So I am going to use CareCredit as my third-party financing company, but there are others out there.
So, if your office is looking to offer this in their — to their patients, then certainly get in touch with them. But what I usually recommend to offices is to at least have two available. So I would pick CareCredit, and I would pick another third-party lender. And that’s going to be up to you whether or not — you know, which one you choose.
Okay. So the third option, again, third-party financing. So, when my patient is in the chair and they’re not really giving me — you know, you can kind of tell they’re not really loving this. And then when I say, “Mrs. Jones, okay. It looks like that didn’t work at all. Are you thinking about how much you could pay every month toward this balance?”
Now, what I did there is I went from knowing that they can’t afford the full payment — the only thing they’re going to go to from there is — well, there’s two. One is they’re not going to get anything done, so that’s, you know — and they’re not going to really tell you that until the end. And the second option, which I hope is true, is that they are going to want to pay a monthly amount.
Now, let’s think about the American consumer for just a minute. We have been trained to think in monthly amounts. Our rent is monthly. Our mortgage is monthly, car payment is monthly, all the bills are monthly. So, when you talk to a patient, what they’re thinking about in their mind is “What can I afford this month? On a monthly basis?”
So any third-party financing company will have charts that tell you for this amount, for this plan, whether it’s 12 months no interest or 18 months interest, they will tell you what the monthly payment amount is. What I like to do in offices is have these websites shortcut and put on the desktop so you can go to them quickly. The patient can at least take a look at how much is available. The calculator is right there. And they have this really great QR code, which is just — it’s like a square barcode. You take a picture of it, and it takes you directly to the application for the patient. You don’t do that. The patient takes out their phone, and they take a picture of it. So they can go — you can say, “You know what? If you’re not interested in this, at least take a picture of this so that you can go back to it and research it on your own should you decide that this is something you want to do.”
Okay. So let me back up a second. Third-party financing. “Mrs. Jones, if we could get this amount to — what are you thinking? Like $400 a month? Would that work for you?” If Mrs. Jones says, “Yes,” great. You’re done with the process. But this is going to take a little bit of extra effort. And I will tell you that this does not — you have to learn this part, and that’s why I think it’s super important to have a third-party company that will — or a third-party financing company that has help available to you in the form of a very active rep. And so that’s why I want you to reach out to the companies and find out what works with that.
Now, you may be mostly clinical and you don’t do this this often; however, most of the reps I’ve talked to are happy to come in and help you work with this. Well, of course with the pandemic they’re not coming in, but they are willing to work with you over Zoom. I know lots of the third-party financing reps who are doing this. They’ve been doing this since the pandemic. They will get on a call with you quickly — it doesn’t need to be an hour — and just work with you on this and kind of give you some verbal skills. Very, very, very, very, helpful if you are transitioning into the administrative side of the office at some point.
Okay. Recapping. Full payment, full payment with a courtesy, third-party financing with this CareCredit, my preference, and then the fourth and final option — which I do not recommend, but many offices do offer this. I’m not a fan, but if your office is one of them, it is what it is. You’re just going to have to make the best of it — the fourth option is you the office holding the bill. So what I mean is instead of setting it up with another company, you’re allowing the patient to make a payment every month, whether it’s $100, whether it’s $400, whether it’s $500.
So the obvious risk with that is that you are now acting as a bank. I don’t like that. I want my cash up front. I’d rather get paid from a third-party financing company or the patient directly for the full amount. I don’t like holding credit. In my plus 20 years of working with patients, I have found that it is about 50/50 on whether or not they’re going to finish out these payment plans. Patients tend to not qualify for third-party financing and then decide on this payment plan.
Now, if they don’t qualify for third-party financing, I’m already concerned. It’s almost like a red flag. So I really cautiously — I urge you to go into this cautiously. I urge you to think about financing the patient very much before you decide that that’s going to be a policy. I would rather it be the three steps only, but I do know that there are many times you are going to want to make an exception. That is why you need standard operating procedures so you know exactly in which instant you would allow an exception or you do not allow an exception.
So, when you’re dealing with money, one overall motto that I have or rule of thumb that I have is that you can’t be — you can’t apply a rule to one person and not to another. It has to be fair across the board. I will tell you that patients, especially if you’re in a small town, they talk. They will accidentally find out about it. Say you give somebody a really good deal. Well, inevitably, they’re going to say something to their cousin or sister or whatever and say, “Oh, you should go and see Doctor Ford because Doctor Ford gives me a courtesy. It’s 15 percent.” Well, meanwhile, they get that courtesy for some other reason, and now here’s somebody coming in that you don’t know that’s asking for it. You have to be consistent across the board on what kind of courtesy you’re giving to a patient and why they are getting it.
So I know this was like a quick and dirty rundown on how to offer financial options to your patients. If you have any questions, let me know. My email is going to be in the show notes. It’s teresa@odysseymgmt.com, which is Odyssey Management but shortened. So odysseymgmt.com.
And, if you’re interested in more management information, go ahead and visit me on the Nobody Told Me That! podcast. And, if you’re interested in dental news, Chew on This with my co-host Kevin Henry is available once again on the Dental Podcast Network.
So let me know if you have any questions, and I hope that this helps you with all of your financial conversations with your patient. I hope you never have to go past step one. That would be an ideal situation.
Thank you.
Michelle Strange: We hope you enjoyed this week’s TIPisode. Be sure to reach out to our guest experts and let them know how helpful their tips were. Follow A Tale of Two Hygienists on Facebook, Instagram, and head over to ataleoftwohygienists.com and subscribe to our newsletter. You can also email us at ataleoftwohygienists@gmail.com, and keep listening for more awesome content from your unofficial dental hygiene podcast.
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