Season 5: Episode 120: Ethical Dentistry: Money, Signatures, and Trust

📍 Hey everyone. Welcome back to Know Silver Spoons podcast. Before we get into this episode, I wanna say something upfront. If you listened to episode one 19 and your first thought was, well, they signed it, or That's just how insurance works, or That would never happen in my office.

Then this episode is for you because that reaction, that's exactly the problem. For those of you who are new around here, my name is Sarah Beth. I am the CEO of Dentistry support, and I've built and led multiple eight figure organizations. I'm a five times CEO, and I was honored to receive the 2025.

BBB Torch Award for ethics. And I don't say that to impress you. I say that because when I talk about situations like this, I'm not speaking from theory. I'm speaking from years of making decisions, leading teams, and holding a very high standard when it comes to how people are treated, especially when money is involved.

Ethical leadership isn't something that I talk about. It's something that I expect. Now, if you didn't listen to episode one 19, go back, pause right here and just go back to that episode. Go listen to it and then come back here.

If you need a quick little refresher, here's what matters. My family walked into a dental office and they had an excellent and amazing, a wonderful experience, until they didn't, and within minutes. That situation turned into confusion, pressure raised voices, and my family being told they couldn't leave without paying $1,460. That's what people are reacting to, but that's not what caused it.

Let me tell you what I heard after that episode went live, because this is where things got really telling for me first, I heard, well, they signed a treatment plan. This one came up a lot, especially in the comment section and in my dms, and every time I read it, I thought the same thing. That's exactly how this happens because if your first instinct is to defend the signature, the highlight, the circling, instead of asking whether the patient actually understood, you are not leading, you are protecting a process.

A signature does not mean anything. If a person signing it didn't fully understand what they were agreeing to, and if that makes you uncomfortable, good. It should. Next I heard, well, her insurance plan is the issue.

Okay? Yes, insurance is complicated. We all know that, but let's be honest about something. Insurance didn't raise voices.

Insurance didn't create pressure. Insurance didn't make a situation spiral out of control. People did the way the situation was handled is what made it unacceptable. And then the third most common reply was, that would never happen in my dental office.

And this is the one that concerns me the most because I have worked with too many practices to believe that line. Situations like this don't come out of nowhere. They come from patterns and if you are not looking for those patterns, you won't see them until it's far too late. Let's talk about what the real issue is.

The deeper, stronger issue here that I wanna talk about, this is about how people in dentistry feel about money. And I'm going to say this very directly. A lot of teams are uncomfortable talking about money, and if you say you're not, if you say that isn't your team, if you say there's no way that's a problem in your office, you're already behind the mark. Now, I'm not saying that your team doesn't care.

I'm just saying that because they're unsure and because they're uncomfortable about money, instead of them owning the conversation. They lean on things like paperwork signatures. This is just how we do it because that feels safer. But I'm gonna ask you, who is that safer for?

Because it's not the patient. And if you are any dental office that I've talked to recently, or anyone who has communicated in any realm with me about patients, about the patient experience, about what your dental office goals are. Keep listening because I promise you, there is someone that you are going to hire in the future. There is a team member probably on your team already that has this mindset of, I'm gonna make really good notes.

I'm gonna make sure I get that signature. I'm gonna make sure I show the paperwork because as long as I have that, I did my part, not my circus, not my monkeys. I did what I was supposed to do on you now. This happens all the time.

Here's the missing piece. In most dental offices, it's not the explanation of what treatment is that someone needs that's missing. It's the confirmation. There is a huge difference here.

You can explain something all day long, but if you never stop and make sure the patient can explain it back, you are guessing. And guessing is what leads to situations like the one in episode one 19 that happened to my family. Now, what I mean by actually making the patient explain it back, it's not just sign here. If you're ready to do treatment, it's not sign here.

If you're okay with everything today, it's not just sign here if you understand this consent form. It's not just that. For clarity, I just wanna make sure you understand what we're doing today, Mrs. Patient, do you understand that you are going to owe $1,460 when you check out today?

Yes. Sarah Beth, I understand I'm gonna owe $1,460 today. Or Mrs. Patient, I'll go ahead and collect from you right now, the $1,460.

That way when you check out today, you'll be all set and you won't have to worry about anything. Now, in the off chance that treatment does change, we may have to collect additional at the end, but I don't foresee that happening, but I wanna let you know that's always a possibility depending on what happens when the doctor gets in there. But if there's a change in money, I promise you'll see me again. We're not just gonna spring that on you.

When you check out today, I've asked the patient to give me payment. I'm talking to them about treatment. I'm going through the process and here in just a little bit, I'm actually gonna go through and give you guys some sample dialogues that will really help you have better conversations with your patients. Now, if you're wondering whether this is happening in your office, let me make it really simple for you.

You don't need a major incident to know. Look at the small moments. If you're ever hearing patients say things like, I didn't know that. Well, that's your answer.

If you're team's ever saying something like, well, we told them, that's your answer. if everything gets blamed on insurance, then that's your answer. If conversations feel rushed, if treatment gets added, same day without a real pause, if people are signing quickly just to get moving and turn over a room, that's your answer. These are not random issues.

They are patterns, and I want you to notice these patterns as you work with your team to improve and grow your practice. Now let's talk about the remedy. Let's talk about fixing what this can look like in your practice so that it doesn't have to look like that anymore. Now, I wanna say this very clearly before we get to the fixing part.

Fixing it doesn't mean everything works out perfectly. Sometimes the patient still owes the money and they're not happy about owing it. Sometimes the insurance still denies a claim and you have to appeal it. Sometimes you appeal the claim and it doesn't work out.

That's real life, but the difference is how you handle it. Saying something like, what was said to me when I asked about the insurance, when I asked about the document that was signed, when I asked about the communication that should never happen in your office is. This specific line. Sarah Beth, I have the paper here that has her signature and I'm going off of the signature.

She signed it. She knew she owed the money and she's gonna have to pay it. Okay. That's not what we're gonna say, and that's not how we should be handling things.

So let's talk about what a real remedy looks like. You slow the situation down immediately. You remove pressure from the patient, you take ownership of the conversation, even if you weren't the one who created the issue, you go back and clarify. You don't repeat.

You explore every option before saying no, and if the outcome is still not ideal, you communicate it in a way that keeps the patient's dignity intact, because at the end of the day, people can handle outcomes. What they don't handle well is feeling blindsided. And let me explain to you very clearly, my family was blindsided. And if any of the terms or the things that I've said here, or the statements that I've said.

Are things that you've heard in your office or you think might be being said in your office? I bet you you have patients who are being blindsided. Now let's get into some of the ways and the verbiage that you can take from this very episode to your team and help coach and train them on right away. Now, before I get into all of this good stuff about verbiage, you know that every episode that we have here at No Silver Spoons goes over a, that's good moment.

But I wanted to give you something truly practical because everything we've talked about up to this point, it comes down to one thing, how your team communicates in the moment. And I want you to hear this so clearly. There is almost nothing in a dental office that can't be worked through insurance issues happen, balances happen, unexpected situations happen. That is not the problem.

The problem is when communication breaks down and the patient feels surprised, confused, pressured, and that's what happened to my family. So if your team can slow down, if they can be clear and show compassion while still being direct, you can handle almost any situation, even when an outcome may not be ideal. So I'm gonna give you exact language that you can use. These are not scripts to memorize, but examples of how to communicate in a way that protects the patient experience and reduces risk.

Now if you are thinking, man, my team needs to be coached on this. I do offer mentorship that's both virtual and in person. So if you and your team are looking for that, you can come to dentistry support.com and you can look at what us and our partner, sister company do together.

We combine forces and we help coach and guide your team to help you both increase profitability, but improve your team's skillset. Everything that you hear on this podcast episode is all free. No training signed up required, but what you will want to do is check out our website, dentistry support.com/free training.

With every podcast episode, we release a free training. So if you don't have it in the budget right now to have our training done on site or virtually totally cool. Keep checking dentistry support.com/freetraining and get your information there.

Work with your team in those short little snippets so that we can level you guys up. Alright, let's get into it. Scenario one, a same day treatment patient with a potential balance. Before we get started today, I wanna pause for a moment and walk through the financial side with you so there are no surprises based on what we're seeing right now, there is the possibility your insurance may not cover this portion, which would leave an estimated patient balance of blank.

If that ends up being the case, would you still want to move forward today or would you prefer we wait until we have a final answer? Now, this is a great scenario for patients who need a pre-treatment estimate. If they don't need a pre-treatment estimate and you are delivering a treatment plan and you understand clearly maybe you already have the pre-treatment estimate in hand, or you already know that this insurance plan will likely cover this procedure, you're gonna confirm their understanding still before proceeding.

I just want to make sure I explain that clearly. Can you walk me through what your portion would be today if insurance doesn't cover that? I want to be sure we're on the same page before we get started. This allows your patient to really communicate back to you.

Oh, Sarah Beth, you said I would owe a thousand dollars. Great. Sounds good. I'll collect that amount right now.

I'm so glad you understand. Do you have any questions for me? We don't have to be scared to tell a patient what they owe because this is just healthcare. That's all it is.

I understand that there is a stigma around dentistry and cost of services and what people interpret those costs to mean, but that isn't your job to defend what the stigma is around dentistry. Your job is to communicate well and early on with your patients so that they really understand. We want to have clarity, and when we don't have clarity, that's when we have these situations where there's pressure raised voices, lack of accountability, lack of communication. We're just trying to brush aside a situation when we don't need to do that.

Okay, let's talk scenario three. Insurance has already denied the claim. Here we go. I want to talk through this with you because I don't want anything to feel unexpected.

Your insurance actually denied the pre-treatment estimate for this portion of your treatment, and I know that's frustrating. We do have a couple of options. We can appeal that pre-treatment estimate and try to get it approved, or we can move forward with treatment today knowing the estimated cost would be $1,000. Let's talk through what feels best for you.

Now, this is the exact situation that happened with my family. They knew the pretreatment estimate was denied, but they did not articulate that to my stepmom. Instead, they just had her sign something and do treatment when on the other side of her mouth, she had a similar procedure done that was covered. Now, had someone said.

I wanna talk through this with you because I don't want anything to feel unexpected. Your insurance actually denied your pre-treatment estimate for this portion of your treatment, and I know this is frustrating. The office didn't do this wrong. The insurance happened to make this decision, and you are relaying that information.

Let's talk about scenario number four when you plan to appeal a decision that's been made. What we can do here is go ahead and submit an appeal with additional information to see if we can get this covered. While this process is happening, I want you to know that there is still a possibility it won't be approved. If that happens, your portion would be around $1,000.

I just want to be upfront with you now so that nothing catches you off guard later. Okay, great. That's fabulous information. Now the patient knows everything and they can either decide to move forward knowing that they could get reimbursed and do that treatment still same day, or they know worst case scenario they had to pay it and nothing's gonna change.

Are you comfortable moving forward with that today? Here's scenario number six, when the outcome is not ideal. Mrs. Patient, I want to be honest with you, this isn't the outcome we were hoping for based on what we have, insurance is not covering this portion.

I know this is not ideal, and I wanna walk through it with you so you understand exactly why and what your options are. Moving forward, we will figure this out together. Now the patient's still going to have an out-of-pocket portion. Did they decide to already go through with treatment before and now you're using this as a follow-up call?

Sure. Maybe. Whatever the situation is, your patient needs to know that you're advocating for them. It's not always going to be an ideal situation.

We're not always going to have the patient win with insurance. We're not always going to have the perfect coverage scenario. But what the patient has to know is that you are clear in how you communicate, and if we are brushing over situations to try to just lock in same day treatment, we're setting ourselves and the team up for failure. All right.

It is now time for our, that's good moment. And the reason why I always have this part of the episode is pretty simple. I don't want you to just listen to every episode and move on. I want you to walk away knowing exactly what to take back into your office, what to take back to your team, and what to do with your own leadership so that you can lead your team well.

So let's lock in the key takeaways from today. A signature does not mean the patient understood anything. It means that they signed something. If a patient is surprised at checkout, something was missed earlier in the process every single time, that's what that means, that every single time, if they're surprised at checkout, something was missed earlier in the process.

Insurance is not the problem. No matter how many podcasts you listen to, how many blogs you read, no matter how many dental conferences you've attended, where someone says Insurance is terrible, insurance is the enemy, insurance is awful. Yes, I understand how they pay and the fees that they pay, and there are aspects of it that are very uncomfortable. I get it.

I also agree that there are things that are not fair about insurance. But if we spend all of our time being negative about insurance, and if we spend all of our energy talking about how terrible it is and leaving this horrible connotation and underlying tone about what insurance is or is not and how awful it is, that's always think about what energy do you wanna give life to? Do you want to sit. In a moment where everything feels good and comfortable and profitable, and there's this prosperity that is underneath what you're working on, or do you want to live in a world where everything feels doom and gloom, where all you discuss are the negative aspects of everything you need to make that choice because what I'm gonna tell you is that insurance is not the problem.

It is how your team communicates around it that determines the outcome. There are many dental practices that are fee for service that are not in network with any insurances, and they collect exactly what they want to collect on every procedure. So if we are going to say insurance is awful, maybe we need to rethink how we are utilizing insurance in our practices. If you cannot beat the insurance company and into submission in some respect.

Then you've got to get better at the game that you're playing, and the game is teaching our team better communication. If your team is rushing conversations, adding treatment same day without pausing for a moment, or relying on paperwork instead of dialogue, you are creating risk whether you realize it or not. And you are never gonna be ready to go fee for service if your team can't get comfortable handling conversations where reimbursements are coming in from insurances. Now, at the point when you have no in-network insurances and you operate on a completely different level, playing field, conversations are different.

So we've gotta get our team up to speed. Most importantly, your goal is not to create perfect outcomes. Your goal is to make sure that no patient ever feels blindsided, confused, or pressured in your dental practice people have been handling hard conversations for centuries. They don't handle feeling caught off guard very well.

That's when our bodies go into fight or flight. So, if you take anything from today, let it be this slow down, be clear and make sure the patient actually understands what's happening before anything moves forward. This episode is brought to you by dentistry support and this right here, this is exactly what we help practice, this fix. Not just what your team says, but how they say it, how they handle pressure, how they communicate about money, insurance, and treatment in a way that actually builds trust instead of breaking it.

Because most practices don't have bad people. They have gaps in communication systems and leadership. And those gaps are what create situations like the one we just talked about. So if you're listening to this and you're thinking, I've seen this happen, or I don't know if my team is as clear as they should be.

That's what we do. We help you identify it, fix it, and build something stronger. We support dental practices nationwide, providing virtual support and dental insurance, eligibility, verification, phone support, credentialing, medical billing for dental, and so much more. Our team also partners with our sister company Dentistry Support Academy for virtual and onsite training.

Fully white labeled training that can be put into SOPs for your dental practices. Take a look at your team this week. Listen to how they explain things, watch how they handle financial conversations. As we close this episode today, I want you to go back and take a look at your team this week.

Listen to how they explain things. Watch how they handle financial conversations. Pay attention to where things feel rushed, unclear, or super uncomfortable, because those small moments are where everything starts. And if you catch them early, you can fix them before they turn into something bigger.

Thank you for 📍 being here, and I'll catch you on the next episode.