Increase case acceptance by becoming a patient-centered practice and offering flexible payment options


Marla Merritt discusses how to make treatment more affordable

Does your practice offer flexible payment options to your patients? Most do not. As a result, the dental industry as a whole is missing out on hundreds of thousands of dollars in recommended but unaccepted cases each year.

Recently, I have visited with several orthodontic and dental practices. The purpose of my visits has been to discuss the financial policies and fee presentation procedures in these practices. It has been an eye opening exercise. Here is what I have observed while in dental practices:

Treatment Coordinator: Mr. Patient … Here is the treatment you need, and the total price will be about $5,500. Here is the information for a company that will provide you with financing. If you do not qualify, payment in full will be due at the time of treatment.

Patient: I know that I need this done. Can we work out some sort of office payment plan?

Treatment Coordinator: I’m sorry. We don’t offer an office payment plan, but here is the information you will need to see if you qualify for financing.

At this point, the patient often walks out the door with sticker shock. Many will never come back to that practice again. Many will shop around to see if they can get a better price or a more flexible payment option. Others will determine that they just can’t afford treatment.

What I have observed in orthodontic practices, however, has been a much different story. Those fee presentations go something like this:

Treatment Coordinator: Mr. Patient …We look forward to working with you and giving you an even more beautiful smile. We typically ask for $1,000 up-front and then let you pay $225 per month interest free for 20 months. Does this work for you?

Patient: Not really. I will have to think this over and get back with you.

Treatment Coordinator: What part of this doesn’t work? Is it the up-front cost? How much do you think you could afford to pay up-front? We can work with you.

At this point, the Treatment Coordinator and the patient engage in dialogue where they work together to come up with something that works for both parties. Practices that are very good at this dialogue are often able to secure an appointment to begin treatment.

The July 1995 issue of Dental Economics magazine carried the headline “Cash or Credit? A Flexible Policy Maximizes Your Cash Flow.” As far back as 20 years ago, consultants were pointing out that it is important for a dental practice to offer flexible payment plans — yet most practices still maintain a “cash only” policy. Let’s explore why this is still happening.

Practices that offer only third-party financing or cash up-front (known as a “cash only” practice), enjoy a 100% collection rate and maintain very low accounts receivable. On the surface, this seems like the perfect solution. However, if we dig a little deeper, the picture looks quite different. First of all, these practices are giving up as much as 10% of their treatment fees to these third party finance companies when patients choose this over true “cash” up-front. Many practices will inflate fees to account for this, making treatment even more out of reach for numerous patients.

Another thing that happens to these “cash only” practices is that they leave behind tens of thousands of dollars in unscheduled production each year. Patients walk away. Many of these are patients who need treatment, who want treatment, and who could afford treatment if only they were offered more flexible payment options.

I am not telling you anything that you didn’t already know. Most specialty dentists realize that being a “cash only” practice creates low case acceptance and a dependency on insurance, but the alternative leaves them even more apprehensive. “I am not going to offer payment plans because I do not want to take the risk of having delinquent payments or nonpayment. Also, taking on patient delinquency opens me up to poor compliance, lawsuits, and a referral pipeline of other nonpaying patients.” This is the argument that I have heard from many dentists.

For 20 years, dental practices have chosen what they consider to be the lesser of two evils. By having a “cash only” practice, they have avoided the headaches involved with offering office payment plans and chasing down missed payments. They have also missed the opportunity for higher case acceptance and increased profitability.

Is there a third choice? Is there a solution that allows for high case acceptance and production, a great collection rate, an efficient schedule, and a high rate of the right kind of patient referrals?

Dental Consultant, Paul Zuelke, recently said, “Stable people with excellent credit can be trusted to keep their financial agreements and should be allowed, when necessary, low and even $0 down payments with fairly long term payment plans.” There are two important things to notice about this statement.

First of all, Zuelke refers to “stable people with excellent credit.” How do you assess if a person is stable and has excellent credit? Fortunately, technology makes that one easy. Credit grades and payment plan recommendations can be obtained in a matter of seconds using an office computer and the Internet. Check out to learn a little more about how this can work in your practice.

The next key point I want to highlight is Zuelke’s mention of “when necessary.” The reason I want to dwell on these two words is because the assumption is that you know when a flexible payment plan is necessary. In my observations, dental practices are not delving into these important conversations with responsible parties to determine what they can reasonably afford up-front and as a monthly payment. When handled properly, these conversations can be the key to great case acceptance.

It is critical, first of all, to have a system in place that allows you to quickly identify the maturity, stability, and credit worthiness of any person. Second, it is important that you have a well trained, pleasant Treatment Coordinator that will work with patients to determine a payment plan that is appropriate for both parties. Once you have these two things in place, you can design payment plans that work for your low risk patients. You will begin to enjoy increased case acceptance, a more predictable flow of monthly income for your practice, and improved profitability.

Before I conclude this article, I want to address two other concerns often expressed to me by dentists who consider offering flexible payment options.

The first concern is in response to my comparison of dental and orthodontic practices. The argument can be made that the risk is inherently less in an orthodontic practice because the patient is making payments while receiving ongoing treatment. This is a very valid point, and it is the reason that utilizing a credit assessment tool is so important for a dental practice. People who have a good credit rating can be counted on to pay all their bills, including their dental bills. These are the people who have earned the opportunity for a flexible payment plan.

The second concern that I often hear relates to what happens after a payment plan is established. Many practices operate with a staff that is at capacity and cannot take on the added burden of managing monthly payment plans. To address this concern, I strongly recommend electronic drafting for all monthly payments. There are a variety of sources that can handle electronic payment drafting. Check out to learn about a drafting company that also follows up with responsible parties if a payment fails for any reason.

In the last 12 months, dental practices have observed a decline in the number of patients that have dental insurance. It is forecasted that there will be an additional 50% decline in the next 3-5 years due to the Affordable Care Act. Now more than ever before, it is important to build a patient centered reputation. Offering a flexible payment policy that makes your treatment affordable is a key factor in building that reputation.

marla-merrit-orthoblancMarla Merritt, Director of Marketing and Sales for OrthoBanc, LLC, has over 22 years of experience in the promotion and sales of risk management services and payment solutions. Her background includes 12 years working for an Equifax affiliate in Chattanooga, Tennessee, where she helped banks, credit unions, and other industries implement risk assessment models into their lending policies. Ms. Merritt is currently with OrthoBanc where she leads the teams that are responsible for sales/marketing, customer setup, training, and customer service. OrthoBanc currently serves over 2,000 providers and has managed payments for over 1.3 million responsible parties. Ms. Merritt secured EXHIBITOR Magazine’s Sizzle Award and also its All Star Award for two of her highly successful, city themed trade-show marketing campaigns.

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