How to present finances for COMPLEX cases

ONE SENTENCE SUMMARY

How we present finances for complex cases like implants and full arches. These treatment plans include extra items that are bundled together and are not "regular fee guide".

HOW IT WORKS

2 things have happened up to this point in the Smile Consult:

1. Records and initial screening by DA or treatment coordinator

2. Discussion with doctor

(Additional training modules are on the way!)

And now we are ready to present finances.

Goal: By the end of this section, the patient should have accepted treatment and scheduled the next visit!

Bundle Fee Sheet

This is an example of the bundle fee sheet we use to show patients how much their treatment plan costs:

The Google Sheets you need to come up with this worksheet are found in this folder:

https://drive.google.com/drive/folders/1nfqJbtUy3wxBMWkGWMHjrOAsV79P33s1?usp=sharing

And here are some videos that walk you through the process:

EXAMPLE #1: Single implant - simplest possible case

EXAMPLE #2: More complex case

EXAMPLE #3: Another complex case

Ready to present finances to the patient?

Step 1- Review and Reinforce

Step 2 - The Bundle

Step 3 - The Savings

STEP 1 - REVIEW AND REINFORCE

YOU: That's amazing that Dr. Ling found a way to get what you want and said you're a great candidate for this plan. How do you feel?

PATIENT: Yes it sounds pretty good.

YOU: And what did you think of the doctor? Was he what you expected?

PATIENT: He was great. He showed me lots of things my old dentist never did.

YOU: Yes! We hear that all the time. Dr. Ling has helped hundreds of people just like you and you are in great hands.

Ok now let me summarize the plan and then I'll go through all the pricing and next steps.

(And then walk the patient through the TREATMENT TIMELINES sheet.)

YOU: I'm really excited about this plan. I think it's perfect for you because you're going to be able eat all those foods you miss, and that you can't eat with your old dentures. And it's going to look AMAZING. When patients go through this treatment they say they look and feel like a whole new person! I'm super excited for you to see what you're going to look and feel like when we're done! How do you feel about this plan?

PATIENT: I'm just worried about the cost.

YOU: Great! Because I'm going to go through all that with you right now!

STEP 2 - THE BUNDLE

(Pull out the bundle sheet)

YOU: Like we said before, we believe in doing things right, the first time. That's why at our office, we don't take any shortcuts or make any compromises when it comes to something as important as your health.

Our prices are all-inclusive. That means there are no hidden or extra fees. I talk to a lot of other patients who were really frustrated by their old dentist because they got a surprise bill at the end of their treatment, and I know you don't want any surprises, right?

PATIENT: Right.

YOU: So to make this easier for you, I've made this price list with everything bundled together that you need from start to finish and the 12 months after we finish, so you know exactly what to expect. Can I walk you through it?

PATIENT: Sure.

YOU: Ok so there are 3 phases to walk you through - the planning, the treatment, and the after-care.

The planning includes the scans, measurements, 3D CBCT, case planning, smile design - it's basically the architectural and engineering plans we need before building a house. We will get all this from you at your next visit.

And then we have the treatment phase, where we are going to give you some sedation, remove your bad teeth, add some bone grafting material so it heals better, place the implants, and then leave you with a fixed, screwed down healing denture. So you will leave that day with a brand new smile and bite. THIS is what makes this All-On-X, or “Teeth In A Day” process so special.

A few months later, once everything has healed, then we verify that everything looks and feels exactly the way you want with a smile prototype, and then when you’re happy with it and everything looks and feels perfect, we deliver your final, permanent zirconia denture.

And then in the maintenance phase, we've added a nightguard to protect your new teeth from too much biting stress and a Waterpik water flosser because that’s the very best way to clean around your new teeth and make sure they last a long time. And then you'll need a maintenance visit at our office at 6 and 12 months to make sure everything is clean and healthy. A lot of dentists only focus on getting the work done and they don’t mention the added costs of maintenance, so I added them here just so there are no surprises.

STEP 3 - THE SAVINGS

YOU: Now - since we do a lot of these cases here we’ve got a really smooth workflow and can do things like order our supplies in bulk. We’ve also got great relationships with our labs and suppliers, so we can pass those savings on to you.

So let me show you what I can give you for no charge, because it turns into a pretty substantial discount.

(Start crossing off the no charge items on the bundle list)

Let’s look at the planning stage. All of these items that we need to get ready for your case like the consultation, cone beam scans, smile design planning, and surgical guides - I can go ahead and give those to you at no charge.

And then for the procedure itself, the sedation, removal of your bad teeth, and bone grafting - those will be free as well.

And then since you are making a big commitment to improving the quality of your life, we want to make sure things last as long as possible, so in the maintenance phase, the Waterpik, protective nightguard and 12 months of maintenance visits I can include at no charge as well.

(Take calculator out and start adding up the savings)

So… this treatment that is normally over $46,000 you are getting for only $36,000. That’s a $10,000 discount because we can do all of this for you in-house. And this is all-inclusive, so you don’t have to worry about extra fees down the road.

Oh and 2 more things.

(Write in 5% discount for payment in full)

First, if you can take care of that full amount using your credit card or line of credit or savings, then I can take another 5% off your total, so your total fee is only $34,200, and you are getting a total of about $12,000 in savings.

And lastly, there’s one more very important and very unique benefit that we offer here that nobody else in the Hamilton area does and that’s a 10 year warranty. That covers you against anything breaking or needing repairs down the road.

Does that sound good to you?

PATIENT: Yes it does! Can I use a credit card?

YOU: Of course! Let’s go ahead and run the full amount on your card right now so you get your 5% discount, and then we will get you scheduled.

What If…

The patient asks how much it costs

We always assume the patient can afford it until they tell us they can’t.

Patient: Everything sounds great, but how much is all of this going to cost? I don’t have unlimited money to spend on this.

You: Of course! Well we have probably a half dozen ways to fix your ___________, all of which have different features and different price points. Have you thought about which features are most important to you? Do you prefer teeth that are fixed in your mouth? Or teeth that snap in and snap out? Which way are you leaning?

(Or for a complex restorative case: Are you hoping to reverse the damage that’s been done over the years so your bite and smile looks and feels like it did when you were in your 20’s? Or are you looking to just maintain things and prevent them from getting worse?)

Patient: I guess that all depends on cost.

You: Ok let me get you an idea of costs so we know we are in the right ballpark. Do you have a budget you were hoping to stay within? Like I said, there are a half dozen ways we can do this, and if you give me an idea of where you wanted to end up in terms of pricing, then I don’t have to go through pricing and the pros and cons for each one. If you have a number in mind, it would be a lot faster to figure out which options are in that range, and which ones we won’t waste your time with.

Patient: Honestly I have no idea. I just wanted to get some basic info and then think about it.

You: Ok - what ballpark are we in? If I told you it costs $70,000, would that be insane? How about $50,000? Or 40? Or 30?

(For minor issues, or if the patient has a handful of teeth to fix, then anything over $2,000 is a good number we can work with. For full arch issues, anything over $5,000 is a number we can work with.)

(If their number is too low, then: I understand. To be honest with you, these solutions can easily cost in the thousands, or even the tens of thousands of dollars. Do you think that’s something worth exploring? IF NO, then: Not a problem. Let’s focus on making sure your mouth is stable and healthy, and we can revisit fixing these other issues later on.)

Patient: Maybe in the 30 range?

(Remember - if a patient says they can afford 30k, the truth is they could probably afford 40 or 50k if they really, really wanted to.)

You: Great! There are definitely some great options for you in that range. My job is to help you find that balance between what you want, what you need, and what you can afford. I’ll make sure we show you what’s available in that ballpark, and we won’t waste your time talking about the $70,000 solutions, ok?

The patient says, “Let me think about it”

Patient: Ok well… let me go home and think about it.

You: No problem. But just so I know, and so I don’t waste any of your time, can we back track a bit and make sure we are on the same page? Based on what you told us you were hoping to achieve - ________________ - does this plan make sense to you? Or are you unsure about which direction you should go? Or is the finances that are holding you back?

(If the patient says they are unsure about the plan, then back up. There’s no sense talking about money until the patient knows what they want. We missed something along the way. Go back to asking questions about exactly what they are hoping for. What do they want the end result to look and feel like? Which features are most important to them - esthetics vs function vs maintenance?)

Patient: Yeah it all sounds good. I just need to figure out the money part.

You: That makes sense. Listen - we can customize this plan to whatever fits best for you. The worst thing would be for you to go through all this trouble and then walk out and continue to suffer with the same problems you’ve had for the past several years. It’s my job to help you find that balance between what you want, what you need, and what you can afford.

Most of our patients like to pay for everything in one lump sum, so that’s the option I presented to you earlier. If the total amount is more than you’re comfortable with right now, we can modify the plan so we end up at a lower dollar amount. Or, if you’d rather not tie up your cash like that, we can break up the whole amount into smaller, more manageable chunks.

Does that make sense to you?

OPTION 1:

Patient: Yeah if we could make a payment plan I might be able to make it work.

You: Ok great! I can definitely help figure that out with you. The way this usually works is people will start with a downpayment and then split the remainder up into monthly payments. What were you thinking of for down payment? Could you do half? 40%? 30%?

Patient: I could probably do 20% and then can I make payments on the rest?

You: I think we can make that work.

(Take out Payment Calculator spreadsheet and start entering the figures)

So your total fee is $45,000. 20% down payment is $9,000. If we spread that over 12 months then your payments are $3,198. How does that sound?

Patient: That’s really high. Let me think about it.

You: Ok - I know $3,198 is more than you’re comfortable with, but it sounds like you have a number that works better for you? Where would you like to be? $3,000? $2,500?

Patient: Actually if we could do like $2,000 that would work.

You: Ok - let’s play with the numbers and see what we can do.

(And then find 2 ways to get to the patient's desired monthly payment.)

Looks like there are 2 ways we can do this.

If you do $9,000 down, then if we spread the payments over 18 months, your monthly payment is $2,195.

The other way we can do it is, if you can increase your down payment to $15,000, then your payments over 12 months are $2,665.

Which works better for you?

OPTION 2:

Patient: Yeah it all makes sense. I just can’t afford $70,000 right now. That’s more than my car costs.

You: I understand. Well the good news is that we have options at lots of different price points. The only reason we arrived at THIS particular option is that it was the one that FIT the best, based on what you told us was most important to you. So let’s back up and find something that works better for you, ok?

Now $70,000 is too out of range right now. So what were you thinking? What would work better for you? Something in the $60,000 range? $50,000?

Patient: To be honest I was hoping to spend around $30,000 total.

(Remember, if the patient says $30,000, their real number is probably $40-50,000.)

You: Ok no problem. Now we’re going to have to make some adjustments to your plan so that we can fit it into your budget, but that’s what I’m here for! We can figure out which features are most important to you, and which ones we are willing to leave for now.

Let’s see what we can do… the original plan was to do fixed implant dentures on the top and on the bottom. But one way we can save costs is by doing fixed on the top, and removable on the bottom. The end result is about 80% as good, but you save a lot of money. Your total cost is now $45,000 instead of $70,000. That gets us closer to your budget range - how does that plan sound?

OR, for a full mouth crown case…

Let’s see what we can do… What if we did just your top teeth, instead of the top AND the bottom? Your top teeth are the ones that show most when you smile. That way you can get 90% of the benefit for 50% of the cost. The total for fixing your top teeth, and some of the major problems on the bottom, comes out to $30,000, which is closer to $20,000 than the $50,000 plan. Does that work better for you?

The patient wants to negotiate price

Patients who want to negotiate price are GREAT, because:

1. They’ve already decided they want to proceed

2. They’ve already decided what they want to pay

We don’t need to spend all kinds of time figuring out what they want, showing them multiple treatment plans, comparing pros and cons, and then following up.

All we need to do is figure out what they want, what they want to pay, and then we can decide if we are willing to meet that price or not.

(NOTE: If there is any available time for this treatment in the doctor’s schedule within the next 2 months, then you have the authority to approve pricing 20% less than our quoted fee. If the doc is booked out 100% for the next 2 months, then we can not negotiate the fee.)

Patient: I’ve talked to a couple dentists before about this. They said I’ve got lots of bone and am a good candidate for implants. I just want to compare prices.

You: That’s great that you’re doing your homework, and it sounds like you’ve got lots of bone which definitely makes things easier.

So a lot of offices give you one price for your treatment, and it’s one plan, take it or leave it. But in reality, for every situation there are probably a half dozen different plans that would work, based on which features are most important and also patients with different budgets.

So that I’m saying is that we can customize your plan to fit within your budget.

It sounds like you’ve been doing your homework and talked to a couple different dentists already. So obviously you have a number in you’re head that you’re trying to get to, because if one of the other dentists had hit that number you would have done your treatment already. So I can save you a lot of time and just cut right to the chase.

Instead of going through all the half dozen different options, and the pricing for each one, and the pros and cons of each one, it would be so much faster and easier if you can give me an idea of what you are hoping to spend. And then I can tell you what kind of treatment we can do for that price point.

So what budget level did you have in mind? $20,000? 15? 10?

Patient: Well I was quoted 3 implants for $12,000.

You: Ok… and you thought that was too expensive? What were you expecting? Something closer to 11? 10? 9?

Patient: Yeah my cousin got 3 implants done for $10,000.

(For minor issues, or if the patient has a handful of teeth to fix, then anything over $2,000 is a good number we can work with. For full arch issues, anything over $5,000 is a number we can work with.)

(If their number is too low, then: I understand. To be honest with you, these solutions can easily cost in the thousands, or even the tens of thousands of dollars. Do you think that’s something worth exploring? IF NO, then: Not a problem. Let’s focus on making sure your mouth is stable and healthy, and we can revisit fixing these other issues later on.)

You: Ok that sounds like we are in the right ballpark. Like I said before, there are a half dozen ways to do this, and some of them are in the $10,000 ballpark. Let’s go ahead and get some xrays so we can figure out which of these plans fits best with what you want, what you need, and what you are hoping to spend.

(Tell the dentist about the patient’s preferred budget so they can design a plan to fit. Later in the consult… pull out the bundle fee sheet and go through it as usual.)

Patient: Well let me go home and think about it.

You: No problem, I completely understand. But just so I know, and that I don’t waste any of your time talking about things you aren’t interested in - are you comfortable with the plan? Or you are thinking about different ways to do this instead?

Patient: No, I know this is what I want.

You: Ok, so then is it the financial part that’s holding you back right now?

Patient: Yes - like I said I had a quote from another dentist that was cheaper.

You: I understand. And I don’t blame you for looking for the best deal possible. As you can see on our pricing sheet, we’ve already given you a ____% discount that comes out to _____ dollars.

I really want to help you get this done. You’ve already been to 3 different dentists, and I would hate for you to keep going back and forth and all over the place. Especially if you’re comfortable with Dr. Ling and our team because finding somewhere you trust will be with you for the long run is super important when you’re considering spending this much money and doing this type of dentistry. So if you can tell me what would work for you in terms of pricing, I’ll see if I can play with the numbers and make it work.

(NOTE: If there is any available time for this treatment in the doctor’s schedule within the next 2 months, then you have the authority to approve pricing 20% less than our quoted fee. If the doc is booked out 100% for the next 2 months, then we can not negotiate the fee.)

Patient: Well my cousin got it done in Mississauga for $10,000. So if you could do $11,000 I’d be ok with that.

You: Ok… that’s another $1,500 discount on top of the ______ dollars already.

(Do the math in your head or on a calculator.)

Hmmm… we don’t normally do this, but I really want to help you get this done. If I can make it work, are you ready to run your credit card today and get started right away?

OPTION 1:

Patient: Yes!

OPTION 2:

Patient: Well… I’m not sure yet.

You: Ok then, why don’t we meet back here again in a week. You keep doing your homework and then you and I can sit down and figure out how to make this work. Just so you know, since we do so many of these cases, about 90% of the time we can beat pricing you get from any other office, so bring any quotes with you and I’ll make sure you get the best deal possible.

Are you free same time next week?