Oral Health Group

Practice Management: Create Successful Financial Communication With Your Patient

June 1, 2003
by Jenny de St. Georges

Why do we need a financial policy?

If we don’t, the patient will give us theirs! If your office does not lay out which methods you wish patients to take care of their financial responsibilities with, when problems arise due to lack of communication, it becomes your problem… not the patient’s, because patients were not educated as to what was expected of them.


Our premise in communicating financially with patients is:

1. They’ve got it and we need it …. the money that is;

2. Ask and ye shall receive …. you don’t ask, you don’t get;

3. Inform before you perform, no surprises …. legally required as well as being good management;

4. Never ask a patient a question unless you are prepared to handle the ‘no’ …..”would you like to pay the $42 today Mrs. Patient?” “No thank you, but thank you for asking me.”

In establishing management policies, the first rule is to have rules about rules.

1. Have a rule for everything …. this allows the team to work off the same page;

2. Know your exceptions …. as much as we would like to think we can treat every situation exactly the same, you know that is never true;

3. Know when to break the rules …. usually for your special patients. It is good PR and marketing;

4. When you break the rules, tell patients, otherwise they think the exception is the rule. …. Consistency is the backbone of good management so it becomes essential to communicate any adjustment to the rule so you don’t confuse the patient later!

Are your practice needs different from most?

Basically, people are people, patients are patients and common sense and logic are not a regional denominator. However, there are three specific areas a practice may need to take into consideration when designing their financial policies:

1. If your community and practice is centered around one large employer, it can become necessary to reflect this fact when designing your general management and financial policies;

2. The personality of doctor may dictate a different slant in how some aspects of management philosophies are developed;

3. Doctor’s professional and personal goals in life may require a management policy adjustment.

Question: When does the doctor discuss money with patients in the clinical area?

Answer: Never. There are, however, three specific occasions when “inform before you perform, no surprises” must be the dentist’s creed:

1. Emergency visits.

The patient must be advised as to a. what the problem is clinically; b. what clinical options are available to the patient to solve the stated problem; c. what costs are involved for the clinical options offered.

2. Change of treatment.

When a patient has been informed a certain tooth is to be restored with a buccal pit, which when the doctor begins to treat the tooth, turns out to need a three rooted endo and a crown, it is both professionally and legally required to inform the patient of the required change, before treatment is rendered.

“Ms. Patient, we had planned on doing a small filling on this tooth, however, now that I have removed all the decay, I have found the tooth to be (state problem). The x-rays did not lead me to believe this tooth was so clinically in need of (state solution) as I have found it to be. We will therefore need to save this tooth with endodontic treatment (give details) and in two months, after a post-op x-ray shows that the tooth has responded successfully to treatment (more details), we will need to cover the tooth with a crown,” (list clinical reasons and benefits).

From a management perspective, to let a patient leave the clinical area and be released to the administrative staff who now advises the patient, after the fact, of the treatment change and accompanying fee change is both unprofessional, and a major root cause of patient dissatisfaction.

3. Treatment of personal friends and relatives of the dentist;

At your daily morning scheduling meeting, when a patient is identified as either a personal friend or relative of Doctor, he/she needs to inform administrative staff of two key items:

a. What courtesy, if any, is to be extended to such a patient?

b. Who is to be designated to inform this patient of any courtesy being offered?

In most cases, administrative staff is now most happy to step up to the plate and take over the collection process. When staff has not been given specific permission by Doctor to take this action, they will stand back and allow Doctor’s friends and relatives to leave the office with no education as to their financial responsibilities. Handling the financial aspects of treating doctor’s personal friends and relatives has been proven to be the staff’s #1 frustration.

Defining the role of the team in communicating financially with patients

Clinical team

When patients ask clinical team members questions about fees and insurance coverage I highly recommend all such questions be referred to the administrative staff. This policy ensures that the clinical team, available to support doctor with the delivery of clinical dentistry does not, in patients eyes, get tied into cost of treatment. Patients need to understand dentistry is diagnosed based on patients needs not their insurance benefits or financial remuneration.

Even more importantly, this approach has two specific benefits for the clinical team: it protects them when they are uncomfortable discussing money as well as protecting the practice when clinical staff is not up-to-date with the latest in insurance limitations, thereby causing potential major collection problems down the road.

Administrative staff

Job description

The job title ‘receptionist’ is banned in dentistry… a title which denotes a person who, in the business world, is assumed not to have the necessary skills to hold down a more responsible position. In the business world, receptionists do not collect money and make executive decisions.

Receptionists ask incoming clients if they would like tea or coffee as well as advising them how the schedule is running.

In dentistry, the administrative staff need strong executive skills and responsibilities and their job titles need to reflect this responsibility. Powerful titles suggest the person bearing the title has authority and the ability to handle the position. For the smaller office, with one person at the front desk, the title is Practice Administrator. As the business staffing expands, so do the titles (scheduling coordinator, financial manager, dental insurance administrator, etc.).

Dress code

I believe there is a huge potential for sending mixed messages to patients when the administrative and clinical staff are seen to be wearing the same attire. Clinical staff are involved in the medical side of the practice. The administrative staff are involved in the business side of the practice and should be dressed accordingly. Research shows that when the business staff change their attire from clinical to business dress, there is an immediate improvement in communicating financially with the patients, resulting in increased cash flow.

Are you a patient of the doctor’s?

It is an essential ingredient of staff training, that all team members receive dental treatment from the doctor for whom they are currently working. Consciously or unconsciously, employees do convey their attitude, level of trust and perception of value for services received, to patients in a manner that defies words. We need this message to be both positive and first-hand.

When business staff specifically have not experienced the same clinical services that they are asking patients to pay for, they can not convey the same passion and understanding for value received for payment being requested.

The importance of consistency in establishing financial options

Lastly, support your staff so they can be more effective in “closing the deal” by offering multiple, attractive payment options. Ensure your financial options by giving your patients every opportunity to choose a method of payment that al
lows them the most flexibility. My personal choices are pre-payment, a retail credit card (MasterCard or Visa), or outside financing. The reader will note that I do not endorse the two most popular payment methods favored by the majority of practices — pay-as-you-go and half at the prep and balance at the cement/deliver stage.


I believe passionately that patients should not be asking Doctor and staff routine questions. If your patients ask a lot of questions, it means that your practice is not being upfront in patient communication. For every patient asking the question, five patients have left the office, wanting to ask a question but didn’t know how to begin. The more thought given by the doctor and staff to understanding their practice philosophies and implementing management policies supported by strong communication skills to support those philosophies, will allow you to experience a stress-free work environment, and satisfied patients who are happy to pay their bills.

Jennifer de St. Georges has presented her practical and motivating “nuts and bolts” programs at virtually every major meeting in the US, Canada and the UK. She has been featured at 16 of the last 18 ADA annual sessions. She is a contributing editor to Dentistry Today — the first non-dentist so appointed. Her company, JdSG International Inc., is based in the San Francisco Bay Area.

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