Last updated on November 3rd, 2017 at 12:25 pm

Greg Winteregg, Dental Consultant - Case Management: 7 Steps to Comprehensive Case Acceptance - The MGE Blog

Welcome back! This is the second part in my series on the exact steps you need to take to get comprehensive treatment plans accepted. In case you missed the first couple steps, click here to read part one.

Now we’ll continue with Step 3:

3. Present the optimum treatment plan.

A compilation of information from a comprehensive exam should provide what’s needed to arrive at what you’d consider an optimum comprehensive treatment plan.  A workable mindset might be: treatment planning as if you (or a loved one) were the patient with the same or very similar diagnoses.  In other words, there are no reservations or considerations about what insurance will cover (or not), there’s no thought about what this patient can (or cannot) afford.  These are not even a part of the equation.

The rule I had was:


It can be both frustrating and time consuming to try to “guess” what a patient will accept.  And even more important, what a patient will or won’t accept has nothing to do, really, with what they actually NEED. And in this respect, modifying your treatment plan based on what you “think” a patient will accept borders on dangerous.  Diagnose and present what a patient needs. Some need little treatment. Some need a lot.  And not everyone will accept – no matter how good you are at case presentations. Obviously the better you are, the higher the percentage of people that will opt to move ahead.  But even then, I’ve yet to see even the best get uniform, long-term 100% acceptance.  And that’s fine. Just make sure you don’t allow economics or insurance concerns seep into your thought process as a clinician or modify the idea of creating and presenting optimum treatment plans.

4. Ensure you have time (and use this time) to address and handle objections.

Case Management: 7 Steps to Comprehensive Case Acceptance - The MGE BlogWe often focus on how a patient will object to or provide reasons why they cannot accept or pay for full (complete) treatment plans.  We can come to expect this.  As sort of a “pre-emptive strike” many doctors try to avoid these objections by compromising their treatment plan in some way, especially with larger plans.

The most common forms this takes are:

  1. Presenting a treatment plan in “phases,” – i.e. we’ll start with ______ treatment (without explaining that there is more). Or
  2. Assuming that a patient would object to a more ideal form of treatment option and presenting only the alternative – i.e. patient has three missing teeth and the doctor presents a partial denture without mentioning any alternatives such as implants or bridge(s).

What’s silly in many of these cases is that it’s the doctor’s own “sales” resistance that’s creating this issue.  In many cases, these patients would probably have accepted the idea or complete treatment plan.  The problem is the doctor “decided” for them – without giving them any opportunity to decide for themselves.

Which leads me to another rule:


So get over it.  They are going to object.  Don’t resist it.  This is where the fun begins.  This leads us to our next rule:


And what’s the difference between a faulty and a legitimate objection?

Let’s start by defining a “faulty” objection. By faulty we mean it’s not the actual reason they don’t want to proceed; it’s just an excuse to get out of being “sold.” This type of objection is usually given when there is no logical reason not to go ahead.

On the other side, some objections are “real,” meaning a valid, logical reason to put off starting and/or paying for treatment. Being able to determine the difference between the two is a valuable skill. What to do when either comes up is even more valuable.

Real versus Faulty Objections

How can you definitively tell the difference between these two types of objections? A couple of points that can steer you in the right direction:

a) A patient will “bounce around” with faulty objections. They’ll tend to “stay put” with the real one.

Case Management: 7 Steps to Comprehensive Case Acceptance - The MGE BlogWith a faulty objection, the patient will tend to offer it up, you’ll handle it and then they’ll use another. Example: Patient says they need to think about it, then after talking to them a bit more, they bring up that they’re very busy right now and so on. This person most likely just doesn’t want to be “sold” and you haven’t found the real reason they don’t want to proceed.

If it’s real, they’ll stick to the same one more or less. If they tell you they want to think about it, you might ask about this and they’ll tell you that they never spend more than $2,000 (the treatment plan is, let’s say, $4,000) without at least 24 hours to think about it or “cool off.” Talking to them some more, you might find that they have done this every time since making a purchase they regretted 20 years ago. And while (believe it or not) we can teach you how to handle this too, for the most part, you’ll have to give the patient their 24 hours to think. If it was the real thing, they’ll probably call 24 hours later to schedule.

b) A patient will open up about a real objection. They won’t with a faulty one.

Faulty Objection:

Doctor: I’d like to get this treatment started as soon as possible.
Patient: I can’t afford it.
Doctor: We have some excellent financing options available.
Patient: I don’t have money right now. I’m also very busy.

In this case, the doctor hasn’t discovered WHY the patient doesn’t want to proceed. It may be that they are afraid of needles, or they heard that it’s painful or that they’ll have to get their teeth get ground down into little nubs and they don’t want that.

Real Objection:

Doctor: I’d like to get this treatment started as soon as possible.
Patient: I know I need it and wish I could, but I can’t afford it right now.
Doctor: We have some excellent financing options available.
Patient: Yeah, I was thinking about that, but I’m in the middle of refinancing my house. I can’t spend money or apply for credit. I have it available on a credit card, and I also might take you up on your financing, but I have to finish the refinancing first. We should be done in a month.

Do you notice how in this example the patient is TALKING? Informing you of what’s actually going on? That’s real! While the patient may have to wait in this scenario, I can more or less guarantee they would be more likely to follow through than in my first “faulty” objection scenario!

What are the main objections you will hear?

  • “I can’t afford this.”
  • “I’m only doing what the insurance covers.”
  • “File a pre-determination of benefits for me.”
  • “I have to check with my spouse.”
  • “I need to think about it.”
  • “I’m too busy and don’t have time right now.”

By my own experience, a majority of the time these objections are faulty.  The patient that wants to keep their teeth will find the time and money.  On the other hand the “spouse” objection might be faulty or real.  Depends.  But in the end, why would people give you these faulty excuses?  Because ultimately they don’t want needles and drills inside their mouth and you haven’t convinced them that your treatment plan is going to help them keep their teeth.  So you have to ask questions to determine if their objection is faulty or legitimate.

“I can’t afford this.”

We don’t know if that is actually true or not.  They probably don’t have the cash on them but I’ll bet they have access to it. You won’t know until you ask them.  You’re going to have to have some courage and ask some personal questions.

I suggest you ask “Could you put that on a credit card?”  Your initial reaction here is probably that that’s being awfully pushy.  That is personal and private, which is true.   But I have a couple of questions for you, doctor:  Do they need it or don’t they?  Would you recommend this treatment to a loved one?  Do you have this kind of dentistry in your mouth?

If the answer to those questions is “No,” then there is no need to try to sell the patient something you don’t believe in.  That would be dishonest and unethical.

But if they do need it to improve their health, then care enough about them to ask them some questions and determine if their stop and barrier is faulty or legitimate.

If they say yes they could put it on a card you have just established that their objection is faulty, so it must be something else.  If they can’t put it on a card, then ask “how is your credit?”  If it is OK then get them approved with a third-party financing company.  If they have no credit then they will need a co-signer.  If they can’t get a co-signer, and there is no other way possible for them to pay, then it’s legitimate that they have no money and can’t get any; so at that point, if it’s clinically acceptable, you can back the treatment plan down to do something to help them.

“I’m only doing what the insurance covers.”

This is an interesting one.  Let’s take a broad look at how people in society feel about teeth and dental insurance:

Some people have their teeth more important than their insurance plan and some have their insurance plan more important than their teeth.

When someone says this, you have to find out which category they fall into.  Then you will know how to proceed.  So my suggestion in how to respond is to ask them ‘Do you want to keep your teeth?’

We need to know the answer to that question to find out if this stop and barrier is faulty or legitimate.  Over 50% of the time they will say that they absolutely want to keep their teeth.  Now we know that their teeth are more important to them than insurance.  This makes it pretty easy to close them.

Let’s say that the treatment plan is $5,000 and they have just said that they want to keep their teeth.  All you have to do is point out that if you only do $1,000 per year, it will take five years to finish and during that time more teeth might break down – possibly be lost (if applicable)  or cost more to fix.  This gets their attention.

This isn’t rocket science or brain surgery.  It’s not adversarial. You’re trying to HELP people and it’s all about communicating with them.

The legitimate objection often revolves around the subject of pain.  They may have had a bad previous experience and they aren’t sure that you aren’t going to hurt them like the last dentist. Maybe a friend told them about a bad experience that they had. Or they may be concerned about postoperative sensitivity.  At any rate, as you are asking questions about their objection to determine if it is faulty or not they will often times originate the legitimate stop and barrier.  Then you can address that until they are comfortable.

So, using the information above, ask questions to determine if the objection(s) is faulty or legitimate.

You get the idea.  I’ll let you figure out some questions to ask for the other objections.

And that’s all the time I have for this week.  In next week’s post we’ll wrap this up with steps 5-7 – beginning with Step 5: Quote the Fee!

Until then.

Click Here to Continue with Part Three!


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