Are your patients taking advantage of you?

Of course you want to help when you can. You want to be flexible and make sure all your patients get the care they need. But you also have to be careful.

Most of your patients, if not all of your patients, are good people, people who need your guidance to ensure they maintain the best oral care possible. Because of that, it’s easy to let your guard down and maybe even become a little too trusting. Even though people generally are good, there are some you need to watch out for, the ones who are always looking for ways to walk away with something for nothing.

So how can you tell when a patient sincerely needs help or when he or she is trying to pull a fast one? Do your research, get to know your patients and pay attention. Here, we break down the different patients who may walk into your office looking to walk out with a freebie.

The sick patient

If a patient you don’t know comes into your office and tells you she has cancer or some other terminal illness, is overwhelmed by bills and can’t pay for needed treatment, don’t question the story in front of the patient but don’t just assume that patient is being truthful. Recently a bride-to-be convinced her community she had terminal cancer, when in fact she wasn’t sick at all. The community came together to help pay for her wedding, only to find out it had all been a lie. Now of course this is an extreme situation, but people can become desperate when they find themselves in tricky financial situations.

So how can you verify such a story? Ask the patient for the name of his or her physician and other doctors on his or her health care team, said Penny Reed Limoli, owner of the Reed Limoli Group. You should talk with them any way if you’re going to provide treatment and become a partner in the patient’s care, and this way you’re able to confirm what the patient is telling you. Check for other community connections through local schools and churches. Ask the patient if he or she is a member of a local church because you’d like to partner with them to help in some way or find out what school their children attend so you can use that avenue to offer help. If the patient is reluctant to give you this information, it’s a sign the story may be made up.

“Most of the time we don’t do our homework at all because who isn’t touched when they hear a story like that?,” Limoli said. “ You don’t want to do background checks but network in the community with other people who know them. It won’t make you bullet proof but it will reduce the likelihood that you are taken advantage of. “

The patient who can’t find work

Yes, times are tough right now and many of your patients struggle to pay for the treatment they need. Many of those patients are willing to work with you to find ways to make payments, but there are others who use the economy as an excuse not to pay their bills.

In the last few years, Kimberly Brozovich, a business advisor at Jameson Management, has seen more and more practices agree to let patients who are struggling financially pay their bills when they can. Yes, it’s tempting to help, but helping too much without any real agreed upon payment could lead you to financial troubles. The problem is, who knows when the patient can make that payment, or if you’ll ever actually get paid for the services you provided.  

“All dentists need to have a written financial policy and even if a patient lost his or her job there needs to be some financial responsibility and a plan of action outlined,” Brozovich said. “Find a way to make financing affordable, whether that’s through Care Credit or some sound financial option. You need a plan other than the patient saying, ‘I’ll just pay when I can.”

Even if a patient tells you upfront he or she doesn’t have a lot of money to pay for dental treatment, don’t let that influence the treatment plan you present, Brozovich said. Always show them all the ideal treatment first, not just the most affordable option. It is easier to present the ideal treatment when you know what your patients’ goals are and what is motivating them to be in your office. Once you identify a patient's goals, then you have an emotional anchor to tie him or her back to. Only then does the dentistry become more of a want versus a need.

“Often times the doctor confuses the treatment plan with the financial arrangement and those should be two separate things,” Brozovich said. “The financial arrangement is a summary of the treatment the patient wants to do and the total fee, and the treatment plan goes through the treatment you want to do and doesn’t include the fee.”

Once you find out your patients’ goals and get them motivated to go through with some of the treatment, you can talk about payment options and even about what they can afford to do right away and what they can wait to do later. But don’t just assume because a patient has lost a job or is struggling financially that you can’t work with that patient to figure out finances. You have to get something from the patient beyond “I’ll pay when I can” before you go forward with treatment.

The patient who forgot his pocketbook

Sometimes, even if you’ve worked a payment agreement out with your patients they show up the day of treatment without the promised payment, Brozovich said. You need to have a protocol in place for such situations to help you decide what to do. Do you go forward with treatment and risk not getting paid, or do you opt for lower production and re-schedule until the patient can make a payment?

“Look at the relationship you have with the patient-- how long have you worked with the patient, is the patient compliant, is this unusual,” she said. “If this is a new patient who needs extensive treatment then you might want to have them call their spouse and take a credit card payment over the phone or look at other revenue resources before treatment is rendered. Look at the treatment you’re providing. If you’re doing six veneers and a new patient is showing up without payment, then you may want to opt to lose that production that day.”

The first time patient

Using deals, such as discounted whitening, are great ways to get first-time patients in the door, but all too-often that first visit ends up being the last, Brozovich said.

Typically, a patient hears about your whitening deal and that’s all that patient wants to talk about once in the chair. This patient isn’t interested in what problems may be going on in his or her mouth. You have to find a way to make this patient a forever patient, and not just someone who comes in, takes advantage of your whitening deal and is never heard from again.

“Dentists often get manipulated in these quick new patient numbers because the number of new patients has gone up but the conversion is very low,” Brozovich said. “If you use something to motivate patients to come into your practice such as whitening, once you get them in the door you want to help support them with goals.”

The perpetually late patient

Patients who take advantage of you and your team don’t always have financial motivations. Sometimes they simply don’t have respect for your schedule, or the fact that there are other patients you have to see throughout the day as well.

Patients who routinely show up late or who don’t show up at all are taking advantage of you and your team, not caring what it does to the rest of your schedule that day. Of course there will be times when patients have emergencies that force them to cancel or show up late, that’s understandable, but you can’t ignore the patients who seem to make a habit of coming in late or missing appointments all together.

So what can you do? Limoli suggests having one of your team members talk with the patient, without being accusatory or negative, about what you can do to help them get to their scheduled appointments on time. Remind them that your team strives to see them in a timely manner and that you need the entire appointment time so that you’re not rushing through treatment.  Ask them what’s the best way to remind them about upcoming appointments and make sure you use that method when it’s time for that next appointment reminder.

If you don’t talk to the patient and ignore the problem, then the patient will think it’s OK and will continue to show up late to appointments, Brozovich said.

“These patients manipulate the doctor so easily because the doctor and the team are passive aggressive with that situation,” Brozovich said. “The patient gives an excuse, the doctor and team accept it and treat the patient or ignore the situation. And so just like you need to have a written financial policy, you also need a written protocol on what to do with late patients.”

You need to decide how late is too late, Brozovich said, and how to communicate that when the patient calls to let you know he or she is running behind schedule.  Don’t make the patient feel bad about being late, but let that patient know you’ll do as much treatment as you can, and sometimes you may need to re-schedule part of the appointment. The appointments are as long as they are for a reason, and if you try to squeeze everything in into a shortened about of time, you won’t be as thorough and at the same time you’re telling the patient you don’t really need an hour to do the exam, 45 minutes is plenty of time.

The emergency patient

These patients only come to your practice when a tooth hurts. They don’t see the value in regular hygiene visits and have no plans to come back to your office once your fix whatever the problem is. You find ways to fit them in, provide same day treatment and then send them on their way until the next emergency comes up.

It’s up to you to give them a reason to come back, Brozovich said. After you’ve dealt with whatever the emergency is, it is important to motivate the patient to come back for a comprehensive exam.  

In most cases, there are more areas in the patient's mouth that need treatment. During the emergency appointment take another photo of an area of the patient’s mouth that needs to be treated and communicate to the patient that you are concerned. Invite the patient back for a comprehensive exam. If you know you’re talking with a patient who’s made a habit of only coming to your office when something hurts, talk to that patient about identifying goals and the importance of prevention. Give him an emotional anchor, something that will change him from an emergency-only patient who only sees you when he absolutely has to, wreaking havoc on your schedule and adding stress to the practice, to one who’s actively involved in improving their oral health.

Take the time

Remember, you don’t need to be suspicious of every patient who walks through your door, but it isn’t a bad idea to get to know them and to be aware of the complications any new patient can bring to your practice. This will not only help you avoid losing out financially on individual cases, it will help you bring more money in as you turn some of these one-time patients into forever patients and perpetually late patients to on-time patients. It’s worth the time and effort it takes to make it happen.