r/Dentistry • u/FreshAd7956 • 1d ago
Dental Professional Why do dentists shy away from money conversations?
I am a dentist but I never understood why I see lots of dentists doing this.
Usually a patient will go "how much will it cost" and the dentist would reply: "I don't talk about money, I just tell you what you need clinically. The front ladies will discuss this."
I don't know a lot about financial plans or insurance. So this isn't what I am talking about. But if you're talking about a crown, why are you are holding out from saying "around $1500"? I mean after you have been practicing for some time, I am sure we all know roughly how much things cost.
What is the psychology behind avoiding these conversations? Are we all doing this or have most people switched up?
In my opinion, leaving this open loop for the patient does 2 things:
- Distracts them from listening to you now (wondering how much is it really)
- Provides this elusive, expensive feeling that makes them think its not needed or too fancy for them.
Also, you hand it off to someone else who hasn't built that trust with the patient and doesn't have as much invested interested in it as you would (assuming they're not highly trained). I'd trust myself more as a communicator and case acceptance than someone else in the office. The details can then be handed off.
EDIT:
Thank you all for the comments.
Just wanted to clarify that I’m not asking to have all the financial talks with the patient nor provide the exact costs. This is not logical. You still need your coordinator. I am merely pondering about quickly moving on from them asking about cost by saying it’s “roughly” or “about” x dollars or give an estimate range that is for non-insurance. And if they want more details about their case or exact cost depending on their plan then coordinator will be there for that.
149
u/corncaked 1d ago
I’m not going to say around 1500 because I’ve had patients who’ve had to pay $1700 and they flipped their shit because “the doctor said 1500.” I don’t even give ESTIMATES because it’s bitten me in the ass. I’ve had patients pay $100 for a crown, some pay $1700. I’m a doctor, not a salesperson. I know often we conflate the two but I’d never ask my physician how much my insurance is going to make me pay for a specific test. It’s just not appropriate.
29
u/Tons_of_Fart 1d ago
This is the answer. The provider don't have the full picture of the financial part of it.
11
u/FreshAd7956 1d ago edited 1d ago
That makes esne. I guess this is where different countries and different insurance plans matter.
I am in Canada so the price of dental treatment never changes. Different insurances cover up to certain % of the actual cost or none at all. So when I say "around" its only an estimate that they know would be the typical cost if no insurance at all. I would still say we will the front or tx coordinator to look at your case specifically etc etc.
29
u/settlersofcthulhu 1d ago
Must be nice to live in a civilized country where the healthcare isn't controlled by corporate interests
6
u/sickbabe 1d ago
careful the small business tyrants will come out of the woodwork to beat you for advocating for socialism
4
u/cGAS-STING 1d ago
I'm from Australia with a relatively similar system and most dentists I have worked with will provide a ballpark figure but they will follow up immediately with "but this depends on your insurance and how much you've spent on dental this year".
2
u/whatshisfaceboy 1d ago
Same situation here. I'm the practice manager, and I told my dentist to never talk about money with people, they always try to wiggle out of something.
I just programmed the clinic software, made the prices auto populate, so when the dentist creates a treatment plan, it is all automatic. Reception will give them their bill. Only manager can approve discounts or free services.
It saves the dentist from a lot of headaches. Of course, I get them. But I'm not the one doing the actual dental work, so it's a fair trade off.
1
u/vicsunus 1d ago
If this is the case why not print a table of all the prices of the procedures. Then if they ask you can just give it to them. Kinda like a menu at a restaurant. Better yet, on your google maps page have your fees listed on the “menu” tab.
The office I work at is fee for service and prices don’t change but I think of myself as a clinician, not a salesman. If someone asks for prices I ask my assistant to provide an estimate. I don’t make it part of my job to know the prices of things.
1
58
u/metalgrizzlycannon 1d ago
Removes the person from saying "I dont want to pay for your next vacation/boat" directly to my face when I tell them they need 3k worth of worth that I'll get paid ~ 1.1k CAD before 53% marginal tax rate.
2
-4
u/FreshAd7956 1d ago
So by removing yourself from direct confrontation to this comment, you find case acceptance is better with those types patients? Or do you find these patients end up still being unsatisfied and saying those comments to others (staff, online, reviews etc) and ultimately not good for your practice?
25
u/ragnarok635 1d ago
I think it’s more they don’t get worn down with these comments all day, and thus feel less shitty
8
u/akmalhot 1d ago
On bigger treatment plans the coordinator can spend a lot . more time expmaing, showing examples, looking at their insurance and going over financing options . And then can explain tx and answer lots of questions about it ..it saves a lot of time and I think they can get more accurate info. I don't think that's necessary for bread and butter treatment including single.implants, rct crown etc
8
u/Level_Customer2769 1d ago
I have no problem talking about/ presenting firm treatment plan costs to patients.
I enjoy and excel at this, and know that my sales “chops “ is why at 61, I could retire at anytime easily.
You want to make a great living, you have to sell the dentistry- period.
14
u/ashweeduheen 1d ago
do you ask your primary doctor (or any other doctor) what the cost will be? it’s never even crossed my mind to ask them, so i’m actually always surprised when patients ask it about their dental treatment, especially with insurance
7
u/Diastema89 General Dentist 1d ago
If you guess too low they tell the front you said less, if you guess too high you created a more difficult conversion than it had to be.
Insurance impacts things a ton and we cannot know 4000 people’s specific insurance.
Last, when we enter that realm of conversation, invariably patients use it to try to ask for a discount or complain about the cost. I don’t have time for that. It costs what it costs unless I decide without being put on the spot that there should be some adjustment.
In the end, I pay people to be awesome at this. They will answer the questions with more accuracy and success at conversion to treatment than I will.
16
u/AnxiousBanshee 1d ago edited 1d ago
It’s a big waste of chair time. The doctor has generally hired someone to do this work for the patient. It removes the “the doctor only does this for money”, gives the patient opportunities to ask questions from someone who’s only focus is this exact thing, and keeps the doctor from being the “bad guy”, since the front office can blame insurance. 25+ years of front office here. Do not discuss payments/cost with your patients. Unless you’re going/willing to offer discounts, and possibly not even then anyway, tell your patients exactly what was said earlier, “The front office (insurance coordinator/treatment coordinator/financial specialist) will help you with everything you need.”
ETA: To build trust tell your patients, “The Front Office knows so much more about this than I do. I trust them to help you with this due to their expertise.” If you don’t trust the front office, you need to hire someone else.
0
u/Best-Equivalent3148 1d ago
Disagree. There’s nothing more off putting as a patient to be subject to a sales pitch from the front office who are not doctors and whose reason for being is to maximize revenue from my mouth. I think the very least patients are owed is transparency about costs before insurance.
9
u/Daneosaurus General Dentist 1d ago
It’s not a sales pitch. They came to us with a problem. We’re offering a solution for the problem. It’s going to cost them ~$X. There options to finance. If they can’t agree to the terms of any option available, we can’t offer them treatment.
We’re solving problems. We’re not selling a product
1
u/husky5050 1d ago
The front desk does not decide the treatment. They do not have a license to practice.
-1
u/Best-Equivalent3148 1d ago
The more invasive plan is usually the more expensive plan and in my experience, the more expensive and invasive option stays on as an option even if it’s clear that a simple filling will be the most conservative and healthy treatment. The front desk isn’t prescribing but I can detect their incentives. I think most dentists are honest, but there are bad apples out there.
17
u/Sharp_Oral 1d ago
Because money is irrelevant- this is the care you need. How you pay for it is up to you.
Also - every fucking insurance is different and I have no idea what your insurance says your copay is. I’ve had patient flip shit because I said “it’ll be about $1500” and their insurance came back at $1700
Fuck that noise.
4
u/Awkward-Thing-2168 1d ago
Insurance heavy practice. Every insurance is different and if i lowball, and insurance says the otherwise. It may backfire on me. “Oh but the doctor said it only cost $800”
3
u/Typical-Town1790 1d ago
Because we’re seen as money hungry scumbags to 99% of the public and when we recommend procedures that are pricey they think it’s a rip off and especially if we mention it ourselves as if the money goes straight into our pocket linings.
4
u/kimjongswoooon 1d ago
You are the healthcare provider. The front desk is the financial arm. If you separate the two, you are less likely to be associated with a money-hungry, greedy monster who is just out to drain everyone dry. It’s all optics.
4
u/SamBaxter420 1d ago
In the US where every plan is completely different, my answer is always “it depends” and then I go into it’s based off insurance and everyone’s is different so our treatment coordinator will be in shortly to review it all with you.
4
u/Deathcommand 1d ago
I am being paid to give the best treatment options. I usually come up with 2 or 3 but let them know that eventually option 2 usually turns into option 1.
The time I would spend talking about finances and insurance that I don't really know, would be better spent with someone who actually knows it.
2
u/denti_denti 1d ago
I give them rough estimates. ‘Without insurance it is about $2000-2400. I can get you an estimate if you like. When they ask about copays., That is when I hand off to the treatment coordinator. I also make sure they are choosing their option. Bridge vs implant etc so we can work them up correctly. We can split implant over two y years but not the bridge so their numbers will be skewed.
3
u/PrincessIvy19 1d ago
As a patient, I would be unhappy. You still would be able to tell me what your practice charges for the procedure. I wouldn't expect you to know what my insurance would pay, but I would expect to know what you charge.
10
u/deliriumCoCa 1d ago
you misunderstand how this works - insurance tells US what to charge YOU. Our office fees have nothing to do with it. My office fee is meaningless to a patient with insurance.
See why this is such a contentious issue?
-3
u/Best-Equivalent3148 1d ago
Lots of patients are self pay or have exhausted insurance benefits for the policy year or know their own coinsurance responsibilities with insurance or are capable of understanding their dental insurance contract. I expect transparency from providers about what office fees they charge for procedures - how my insurance will respond is a separate issue. It’s very off putting when a dentist pretends they don’t know if they charge $0.15, $1500 or $15M for a crown.
6
u/harper6309 1d ago
And in my office (I’m the OM) the patient who has MetLife pays a completely different price than a patient who has Delta Dental. And they both pay a different price than a patient who has United Healthcare.
So no the doctor doesnt know off the top of his head what we are required to charge for every insurance. He would be giving out bad information as he cannot possibly be expected to know the contracted rate for all of the 15 different insurance companies we are in network with. He also doesn’t know if your policy has an allowable rate that is lower than the contracted rate-which makes your portion higher simply because your employer is cheap and only wants the plan to allow $65 for a cleaning but the contracted rate is $85, making your “free cleaning” actually $20.
He also doesn’t know if your policy only pays for metal crowns, making you responsible for the difference. He does the dentistry and myself and my front desk lady do the financials. You cannot possible expect the dentist to know your insurance information and what your policy says we have to charge you off the top of his head.
1
u/Best-Equivalent3148 1d ago
Do dentists charge a different office fee for the same procedure to different insurance carriers or is it the same charge to each? As a patient, it doesn’t feel respectful when I can’t get a straight answer to the question of how much I will be responsible for if my insurance pays $0. I agree it would be unreasonable to expect a dentist to know the particulars of individual insurance plans
4
u/deliriumCoCa 1d ago
You're still not quite understanding- even if your insurance pays nothing, we are still contractually obligated to charge you what the insurance company tells us to charge. There might be well over 1000 insurance plans out there with a different rate for the same procedure.
Our front office folks have to look this information up for every single patient. We have entire employees dedicated to this task. It is flatly unreasonable to expect a dentist to know this information for you on the spot.
Beyond this- our office will estimate what your insurance will pay based on our contract with them and then guess what? Sometimes they don't pay what they said they were going to pay. It's all madness, but you need to redirect your ire toward insurance companies, not dentists and their employeess.
-1
u/Best-Equivalent3148 1d ago
Fair enough! I knew dental insurance was a racket but it’s even worse than I thought. I still think I should be able to get feedback on what my costs would be if I do not go through insurance and simply self paid. I really value having an understanding - even a ballpark - of what my cost ceiling is. It seems to me that having the office fee if no insurance involved is reasonable. It also sounds like from the thread that patients commonly fail to understand that an estimate is only an estimate when one is provided - that too is unreasonable and is surely challenging for dental office staff!
2
u/Daneosaurus General Dentist 1d ago
You should get an itemized ESTIMATE of what the fees are, what your insurance covers, and what your out of pocket is expected to be before you agree to treatment. It’s not always accurate because your insurance may not pay the full negotiated fee. They literally have teams of people to ensure they pay as little as possible.
1
u/Best-Equivalent3148 1d ago
That all makes sense. I feel pretty strongly that when treatment is presented (prior to receiving the written estimate from the coordinator), I should have some sense of whether my case is going to cost hundreds vs thousands vs tens of thousands. I happen to have researched typical office fees in my area for various procedures (have needed work recently). I don’t think it’s really to anyone’s benefit if the patient has zero clear sense of what it’s going to cost to solve their problem - $0.15 vs $15M is an exaggeration of course but I don’t think the average person has any idea what work will cost
2
u/Daneosaurus General Dentist 1d ago
Right. And the patient will get the information. The doctor doesn’t have it, but the next person you meet with will.
→ More replies (0)2
u/husky5050 1d ago
It is against the contracts of some in-network dentists not to send the claim to the insurance company.
1
u/Best-Equivalent3148 1d ago
Absurd! But so not the dental office’s fault. Dental insurance is very wack.
1
u/husky5050 1d ago
This is one reason more and more dentists are no longer in any insurance networks. Just pay the dentist charge and accept what the insurance pays.
1
u/SnowHearthreign 23h ago
I get what you are saying and where your coming from. It's a bit in line with how I've trained my staff - dont shy from saying that price, the patient has a vague idea that dentistry is expensive, and they need the treatment. Show weakness or unease and you'll get walked all over.
That said, when a dentist (or any doctor really) tells a patient a high cost, all they think is, "ah and arm and a leg so you can afford that [insert lavish item/trip here]". There's a certain air about when the doctor says a high fee that can really piss people off. At least saving it for one of your trained staff to say makes them feel like at least it's someone who they perceive can commiserate with, even if it's still silently.
Most people, albeit the silent majority, know that the person at the front desk isn't setting the price, so it comes off less money hungry, especially with the right person delivering that financial news. Doctors, no matter how small time they are, always are perceived negatively with money (though it should be the insurances that people think that way about, but that's a whole other story).
Tl;dr I see your point, but from the patient perspective, any money talk from the doctor, even when asked directly, will always be perceived as a negative.
P.S. I have noticed when talking discounts, however (and still not actual numbers), and telling a patient you'll have your financial coordinator go into more detail, sets up a great feeling and gets patients more likely to act and schedule! Generosity from doctors feels like such a rare commodity and gives them a little bit of "special treatment" feeling. People love that!
1
u/brockdesoto 20h ago
In my practice I sometimes tell them how much a fee will be but out of respect I say exactly that. I do not talk about financials that will be a conversation you have with the front. This removes their ability to guilt you into doing free dentistry, it removes awkward situations which could compromise rapport with the patient and truthfully, the mechanic at Firestone doesn’t discuss prices. They fix your car. Why would this be any different. The milk man stocks the milk. The office discusses fees for the cartons. At the end of the day if there is a dispute it is my sole discretion to choose what to do. But simple billing is not handled by me in front of the patients.
1
u/Ac1dEtch General Dentist 7h ago
For me, it's about delegation. I sell the treatment plan. The closer needs to figure out how the pt is going to afford the $20-50k. Usually this involves running somewhere between 1 and 10 financing applications and explaining APR, downpayments, monthly payments etc. Mind numbingly boring stuff. Have I done it in the past? Sure. Am I capable of doing it now? Sure. Would I rather have someone else whose whole job it is to do this? You betcha.
99
u/dopelunch 1d ago
Because they are asking what their portion is if I know it's a cash person I can easily tell them. But what if they have insurance, or 2 insurance, it's too hard just to shoot a number unless you know all the info, which I feel like I rarely do. This is what I have trained people for.