Get comfortable with discussing fees

Dec. 1, 2001
The treatment plans could range from $1,000 to $50,000. We need to feel comfortable in discussing ways of making it affordable.

The treatment plans could range from $1,000 to $50,000. We need to feel comfortable in discussing ways of making it affordable.

One aspect of a comprehensive esthetic and restorative practice is profitability. As dental hygienists, we often speak of a desire to work in state-of-the-art practices. We realize that some innovative periodontal treatment modalities may involve new high-tech equipment or top-of-the-line products. But, in the same breath, we constantly challenge the ethics or motives of some doctors who want to make a good living and charge fees based on their expertise, skills, and knowledge.

Making money is not bad. Providing for your family and having the doctor provide for his/her family do not have to compete with providing quality client-centered care. In fact, if you spend some time looking at the situation, how can a doctor provide individualized clinical excellence in a modern facility and support the needs of a sophisticated team via managed care plans and preauthorizations? If a practice is dependent on insurance reimbursements as the sole means of getting paid, then that is where the "prophy mill" mentality or the "cleaning lady syndrome" has its roots. Why? Because the office has to count on quantity vs. quality in order to meet basic salary, facility, and fixed overhead expenses.

If a practice's receivables are totally dependent on what insurance will cover, then how can it prudently build a solid fiscal base and support uninsured procedures that are well established in current research? When we allow the insurance company or the client's benefits plan to overshadow our clinical treatment models, that is when the question of ethics should come in, not if the practice charges too much for a fluoride treatment.

Look at it from another angle. Maybe someday hygienists nationwide will be able to open oral health practices. You presumably will choose to provide independent, elite oral hygiene services with the best equipment in a contemporary setting, as well as take home an above-average income. Do you honestly think your business will be able to survive solely on what an insurance company decides to reimburse you for their "authorized-only services?"

Once a doctor has adopted the attitude and practice philosophy of not allowing insurance companies to dictate the delivery and fee structure of care, excellence can be achieved. And after the doctor is more financially secure, the next logical step in the process to excellence is to support the team's goals. This includes evaluating and redefining the hygienist's departmental budget in order to allocate expenditures for services such as a laser, laser-assisted perio therapy, and premium hygiene products. In the end, the client will actually receive enhanced services and care.

How can hygienists support a more insurance-independent practice environment? First of all, do not be ashamed of the fee schedule. Whether it is $200, $4,000, or $30,000, start getting comfortable with discussing fees.

The first way to become comfortable with talking about money is to determine if you have any unresolved money issues. By acknowledging, understanding, dealing with, and overcoming your personal obstacles to money or the fee structure, it will no longer be necessary to prediagnose the client's pocketbook or yours before recommending treatments. It will help you to unleash your comprehensive pre-diagnostic assessment and case enrollment skills.

If, in turn, clients make a comment that they perceive a fee to be high, respond with a confidence based on your communication style and the client's personality profile:

"One of the major reasons our crowns may be more expensive than some of the fees that you have heard in other offices is Dr. W. herself. Dr. W. is a caring, knowledgeable dentist. She is fanatical and passionate about what she does. She only partners with the most superb dental laboratory technicians who work with the top-notch laboratories to help create personalized smiles. Her standard for restorative materials far exceeds average, and she will not be happy until you are happy with the result! Some of our other clients first thought that the fees were higher. But what they found out was that, years after having their new smiles, they did not remember the fee — they live everyday with how their smiles feel and look."

What's missing from the above statement?

During any given day, you could have just completed a top-notch, comprehensive prediagnostic clinical analysis with appropriate supportive radiographs, intraoral pictures, educational tools, high-tech gadgets, etc. You have a complete understanding about the client's perspective of his or her oral health needs, wants, concerns, and smile desires. But if you do not ask the final question about getting started, the patient probably will not do it.

So make sure you conclude with the statement: "Would you like to schedule it today?"

The client may resist beginning treatment. After asking some additional open-ended questions, you discover that the barrier is money. What a typical hygienist might say is:

  • "I know the total fee of $20,000 is a lot of money. Why don't we write 'no treatment' at this time in your chart before the doctor comes in for the examination."
  • "We can send in a preauthorization for you."
  • "I do not know anything about fees, so I will have our financial coordinator handle your questions."

The above responses are almost an admission of guilt for the high treatment fee or the desire to avoid discussing the details of money with a client. As providers of care, a hygienist should be aware of the payment menu that the practice provides. Comprehensive esthetic and restorative dentistry is an investment. The treatment plans could range from $1,000 to $50,000. We need to feel comfortable in discussing ways of making it affordable.

Some offices require their clients to reserve their appointments in advance by prepaying. I know what some of you may be thinking: "Paying before treatment would never work in my area." Well, plastic surgeons have been doing business with prepayments since their beginning. Try to have a tummy tuck or an eyelid lift without your checkbook and see what happens — certainly not your plastic surgery! Remember, many esthetic offices are carving out niches for themselves in cosmetic dentistry. So ask yourself: Why do we "feel bad" about stating and collecting fees?

Most esthetic practices offer more than one choice. Some options are:

  • Five percent bookkeeping reduction when the fee is paid in advance
  • Outside financing for either extended payment plans or no interest plans, such as Enhance Patient Financing, Inc. ( or Dental Fee Plan (
  • Visa, MasterCard and/or American Express

A more proactive follow-up could be:

"Mrs. Client, our office provides many investment options. For example, you could save 5 percent of the total fee, or we could break the total fee down to, say, $300 a month. Does any of these options seem like they would work within your budget? I am confident that together, you and Sally, our financial coordinator, will be able to determine which option is best for you to make your new smile a reality."

Right now, this instant, take a quick break from reading. Try and close the magazine. Close the magazine, put it away, and then reopen it later (at my column, of course.) What happened? You either closed the magazine or you did not. You cannot try to do something; you either do it or you don't do it. So do not try to get more recare clients enrolled in their restorative or periodontal treatments; just do it.

How? Conquer your personal demons and then discover, examine, and ask!

Kristine A. Hodsdon, RDH, BS, presents seminars nationally about

esthetic hygiene. She also has developed Pre-D Systems, a pre-diagnostic computerized clinical checklist for oral health professionals. She can be contacted through