Collecting Payment Out of Network

How do you collect payment when you are out of network, and the company prohibits patients from assigning benefits to the practice?

What are the patient’s payment options?  Can the patient use HSA/FSA? 

The answer is that the patient can use HSA/FSA to pay the practice in full and then reimburse their HSA/FSA when the insurance reimbursement check is received.

According to the IRS website:  “If amounts were distributed during the year from an HSA because of a mistake of fact due to reasonable cause, the account beneficiary may repay the mistaken distribution no later than the due date of the tax return (not counting extensions) following the first year the account beneficiary knew or should have known the distribution was a mistake.”  

This rule covers the scenario where a patient charges 100% of the dental treatment fee to their HSA/FSA because the exact insurance reimbursement amount is unknown at the time of treatment, and the insurance company subsequently sends the patient a check for partial reimbursement.  The IRS has a form for this purpose.

It would be easier for the patient to put the full treatment amount on their credit card and subsequently get reimbursed to the extent allowed by the insurance company. 

There is another very good option.  According to CareCredit®, if the practice is out of network with the patient’s dental insurance carrier, the patient can charge the full amount of the fee to CareCredit®. When the patient receives partial reimbursement from the insurance company, the patient has the option of putting those funds toward early repayment of the CareCredit® balance.  

The patient is not obligated to use those funds to accelerate CareCredit®repayment, of course.  The patient only needs to pay off their CareCredit® balance within the prescribed interest free period to avoid interest charges.

By being aware of these payment options, practices can be best prepared when dealing with out-of-network insurance questions.

Recognizing a Major Patient Education Problem–Illiteracy

According to the U.S. Department of Education, 54% of U.S. adults 16-74 years old–about 130 million people–lack proficiency in literacy.  These individuals have a reading aptitude below the sixth-grade level.

There are numerous reasons for this shocking statistic: poor education, learning difficulties, learning English as a second language, or simply lack of exposure to English.  These issues are apparent across many demographics and may affect even high achievers.  For example, an adult literacy program reported that one student was a well-respected cardiologist in his home country, but when he came to the United States mid-career, he was not able to read and write English.

There are four learning styles:

  • Auditory (listening)
  • Reading (comprehending written materials)
  • Visual (seeing)
  • Hands-on (kinesthetic or learning by doing)

For individuals who do not have a good command of English, verbal explanations may not be clearly understood.  Those with underdeveloped reading skills may have difficulty reading printed instructions or patient education information on a website.

This problem is compounded because it is not uncommon for people to be embarrassed by their lack of reading ability.  Stories abound of adults hiding their illiteracy or procrastinating for years before enrolling in a reading program, which are often taught be volunteer tutors.  There are patients in your office every week who sign forms and appear to understand spoken and written instructions but who do not fully understand the messages you are conveying.

For these patients, visual representations such as photos (intraoral and extraoral), x-rays, and videos are very useful.  Allowing a patient to handle a model also helps them understand the treatment plan. 

No More Deer in the Headlights:  Speaking Confidently About Fees Chairside

Most dental team training programs have a glaring omission: clinical team members are often not trained to answer patients’ questions regarding fees.  Administrative team members at the front deal with these questions every day, and many are quite adept at explaining value for the dollar with regard to proposed treatment.  However, when patients turn to an assistant or a hygienist chairside and express concern about dental fees, the clinical staff are often unprepared.

It is common for back-office team members to be uncomfortable with these types of questions.  They may respond by saying, “You have to speak to someone up front about that,” which is a true statement except that it is often conveyed in a halting tone that betrays a lack of confidence.  The effect that financial questions have on assistants and hygienists is similar to Superman being exposed to kryptonite.  Over the years, the super-human caped crusader was unstoppable—until he was exposed to material from Krypton, his home planet.  Back-office team members should not lose their superpowers when a patient asks why a procedure seems so expensive.

Here are three very good answers when patients ask about fees chairside.  My comments are in italics.

  1.  Our fees reflect the quality of care provided uniquely to you. Dr. Smile uses only the best materials and technology.  This statement brims with confidence and reinforces value for the dollar. 
  2. It’s a great investment in your health.  You deserve it.  Patients need to hear again from their trusted assistant or hygienist that the proposed treatment is in their best interest.
  3. Patients tell us all the time that they wish they had decided sooner to have the treatment.  Let’s go to the front and you can speak to Julie about different financial options.  This transition is seamless and can be used with any of these answers.

Clinical team members are not expected to make financial arrangements or discuss fees in depth with patients.  However, their verbal responses to patients’ questions about fees and body language are very important.  The deer-in-the-headlights look is an expression of anxiety.    When all dental team members are properly trained to handle the money question and respond succinctly with rock-solid confidence, patients feel more comfortable moving forward with recommended treatment.  Practices owe it to the team and the patients to provide such training.

Finishing the Year Strong

It’s time to gear up for the race to the end of 2020.  The upcoming holidays are our signal to turn the page, focus on success, and forge ahead.

I received a very kind note from a client as we wrapped up a long and successful project. “Your counsel provided my practice with the boost it needed to get over some tough times which in turn significantly reduced my personal stress levels,” he wrote.

I appreciated his comments because that is why I am here—to advise, be a sounding board, train the team, help increase production and case acceptance, and chart a path to success.

The best way to prepare for a strong 2021 is to finish 2020 on a high note. There is much work to be done in dental practices to make up for lost time and be positioned for the future.

I am optimistic that, at least from a business point of view, we have turned the corner as we roll into a new year.  Better days lie ahead.   

Some questions to ask yourself.  Will there be changes in the practice related to:

  • New team members?
  • New doctor?
  • Office renovation or new office?
  • Changes in insurance reimbursement?
  • Planning to retire within the next five years?
  • New technology or services offered?
  • Changes in hours of operation or scheduled appointment times?
  • Increased overhead?

The time to address these issues is now.  With good planning, 2021 can be a great success.  Let’s have a conversation.  To set up a call, contact me at

The Secret Statistic that is Costing You Money

There is a  secret statistic that’s costing you money!  Today’s episode of The Personal Report is all about converting more prospective to patients to actual patients.  To see the video now on YouTube, click here.

You track so many things, number of new patients per month, production collections, insurance versus fee for service, everything.  You track all this stuff, but there’s one thing that you’re not tracking.  It’s the secret statistic.  What is it? If I tell you, it won’t be a secret.  I’m going to tell you anyway.  The secret statistic that is costing you money is the number of potential new patients who call each month but do not appoint.  They call, they have a conversation, but they do not appoint.  They just fade away.  They get off the phone.

It’s not that no one’s trying to appoint them, but it doesn’t happen.  Let me give you an example.  I was listening to recorded conversations, HIPAA compliant.  The patients were told that the calls would be used for training purposes, and I listened to some calls, many calls in fact, and there was a theme, a thread that ran through them.

I remember this one man who called.  He talked for 10 minutes.  He was a well-educated man.  He had so many issues, so many problems and the person on the phone was polite and courteous.  It turns out he lived five minutes from the office.  He had a good job.  I was thinking this is going to be a great patient, but after 10 minutes on the phone, he hung up.

I should explain hang-up, in the modern sense.  The old fashioned hang up if you watch old movies is “I don’t want to talk to you anymore” and they would hang up the phone.

That’s not the modern hang-up.  The modern hang-up goes like this.  “Well, thank you very much.” They just get right off the phone.   As soon as they say that they’re gone.  What do you do with these folks?  We can’t call them back.  Due to HIPAA, we can’t call them and ask, “Did you call a dental office?”

What are we going to do? Let me give you some tips.  First of all, early in the conversation, what many large companies do, what medium size companies do, and actually what small businesses, including dental practices are doing now–you use this phrase:  “In case we get disconnected, may I please have your name and contact number?”  It works like a charm.  Ninety five percent of the people say yes and they’ll give it to you.

You’ve got their name and you’ve got their contact number.  By the way, there are dropped calls from people on their cell phones .  A lot of these don’t call back.  If you’ve got their contact number, you can call them back.  We’re going to give this one shot, one shot only.  We’re going to call them a couple of days later. “Hi, Mrs. Higgenlooper.  That so and so calling from Dr.  Smile’s office.  We were chatting on the phone the other day.  I’m just calling to follow up, help you make an appointment, answer any questions.”

If you get voicemail, fine; just leave a message.  You’re going to give it one shot.  Does this work? Yes.  In some cases.   Wayne Gretzky, the famous hockey player said, “you miss 100 percent of the shots you don’t take.” So if we don’t have their name and number, we can’t call them.  If we do have it and we call, we’re going to pick up some people.

So here’s what I want to set for you as a goal.  Now that you know that this is the secret statistic and you should be writing it down, track it every month, write down how many calls you got in the previous month from potential new patients that did not result in an appointment.  Was it two? Was it four? Was it six or seven? I don’t know how many you will get, but every practice gets them.  Write it down.  Make a note.

Here’s your goal.   Reduce the number of calls without appointments by one each month, so every month we get x number of these calls.  We’re going to reduce the number that don’t convert by one, so if you do that, you’ll pick up 12 additional new patients per year.  Is that significant? You bet.

These are really good tips and now you know the secrets statistic.  You’ll be tracking it and with some consistency and persistence on your part, you’ll be able to pick up that additional one patient per month.

No Cost Dental Team Motivation

No Cost Dental Team Motivation is the topic of Episode 2 of The Personal Report, which is now available on YouTube. To see the video, click here:

Here’s the transcript of Episode 2 on motivation.

We have a great topic for you today: No Cost Team Motivation. So, how do we keep the team motivated?

Well, let me just tell you a little story. Some years ago, I was involved in a focus group. Do you ever watch “Law and Order”? They watch through the glass and they’ve got somebody in the box and the people who are being interrogated can’t see you through the one-way mirror.

Well, a focus group works that way and we interviewed people who are in the dental profession, hygienists and assistants, and so forth, and asked them what motivated them. We actually divided them into two groups. We preselected them, through a survey, happy people and unhappy people. And it didn’t matter whether we interviewed the happy people or the unhappy people: when they made a list with the focus group facilitator about what motivated them, money was not number one. Oh, it was on the list, and it’s important, but it wasn’t number one.

You know what number one was? Praise, recognition, somebody cares, somebody noticed. So, the no cost way is to praise, but let’s be more specific about that, and when you give praise, always make it specific. Don’t just say, “Oh, you know, you’re wonderful,” or “Oh, I’m so happy you’re here.” That’s good, you need to say that, but make it more specific. “Yesterday, when the patient was starting to get upset, you handled it so well.” The other day the entire schedule was going to fall apart, but you got on the phone and we had a good schedule. The schedule is full–wow, what a great job!”

So you want to be very specific in your praise. We always say, praise in public, criticize in private. Now, you can praise in private, but if you happen to say it publicly, if you praise in public, if other people hear the praise, believe me, the person who’s hearing the praise, they’re not going to mind that other people know that somebody is getting praise and that they’re the one who’s being praised, because they did a good job for something specific.

Any criticism, though, has to be in private. No matter how mild the criticism, you want to really make that private, but that praise, specific praise, and public praise, are very, very important. And the next thing I will tell you is, don’t couch the praise; never use the word “but” when you’re praising.

Here’s what you don’t want to do: you don’t want to say, “You know yesterday, you stayed late, nobody asked you stay late, You took your initiative and you just did it without anybody asking and you got all the work done, but you know, if you were more organized, you wouldn’t have to stay late.” You’ve just taken it all away. First you were on a roll, you were saying all these good things, and then you added “but,” and here comes some criticism in underneath.

Praise is praise. “You did a great job.” Period. And let people know that. Now, if at another time, you need to talk to somebody on the side and say, “work on your organizational skills,” that’s a different story, but praise has to be specific and it has to be unqualified; we don’t want to say the word “but.”

Let me leave you with this thought: when I talk about praise, I can just hear all the staff out there saying, “yeah, I’ve got to get the doctor to watch this video. See, see, you should say nice things about us.” Okay, fair point, but I think that everybody on the team needs to praise other people on the team–when it’s deserved, of course. When somebody does something praise worthy, don’t be shy, tell them. And, by the way, sometimes even the doctor does something praise worthy and you can say something nice about him or her also.

I hope you’re enjoying the Personal Report. You know, I do have my Free Report; we’re getting a lot of good feedback. If you want a copy of the Free Report, “The Three Mistakes Every Dental Practice Must Avoid,” then just go to Just send a quick email to and we’ll send you the Free Report.

You’re always, of course, welcome to contact me through my website, which is Thanks so much for watching The Personal Report.

You May Need a Coach If. . .

Great athletes need coaches.  Great dentists need coaches, too.  Take advantage of the free consultation offer below.

You may need a dental coach if:

  1. You are facing major decisions about the future of your practice. You are wondering if you should buy, sell, expand, cut back, or bring in another dentist.  Ask yourself:  Do I need a trusted confident, outside of my business and family—someone who can lead me to the right choices?
  2. You feel that your team needs more training. Ask yourself:  Could targeted training for specific individuals improve their performance and help the bottom line?
  3. You are not sure if all team members “get it.” Ask yourself: Have I clearly and consistently communicated my expectations to my team?
  4. You feel that your practice has reached a plateau. Ask yourself:  Am I feeling burned out?  Or, do I have a lot of energy but just need direction?
  5. You think that case acceptance should be higher. Ask yourself:  Am I using the best verbal skills and teaching my team to follow my lead?  Do I have an effective follow-up protocol in place to prevent patients from “falling through the cracks”?
  6. You are feeling unsure about your management style. Ask yourself: As an employer, am I too harsh, too lenient, or just right? 
  7. You are worried about overhead but you need more help at busy times. Ask yourself: Am I adequately staffed to provide outstanding customer service?  Am I utilizing the full talents of everyone on the payroll?

If you answered yes to one or more of these questions—or if you have other issues that you would like to discuss in confidence with a highly experienced dental coach, please contact me.

Coaching services are conducted by phone consultations, in-person visits to the office, or both.

Free consultation.  Contact me to schedule a free 30-minute telephone coaching session (limited time offer) so I can start helping you immediately.  I promise to listen carefully and provide cogent, confidential advice.

Click for contact info.

Subscribe to The Personal Report video program.

Diffusing Difficult Situations in the Dental Office

The Personal Report has just launched on YouTube!  To see the video, click hereThe Personal Report will appear regularly with new episodes to help you train your team, educate your patients, and grow your practice.

Here is the transcript of Episode 1.

Welcome to The Personal Report.   Today, we have a great topic for you. It’s called “How to Diffuse Difficult Situations in the Dental Office.” Are there difficult situation in the dental office? You bet. Most patients are very nice, but every once in a while, we have conflicts. We have tension.

Why do you want to diffuse them? Because you want to release the anxiety. You want everybody to relax. You want the patients to be relaxed and happy, the staff to be relaxed and happy, and you want case acceptance to go up.

So how do we do that? We do it through some great verbal skills.

Let me tell you a story. We had a person that I worked with. She worked in the dental office, really terrific person, and her doctor’s fantastic, but there was a problem. She said that sometimes she would get flummoxed. She would get upset. She was not using the right verbal skills with patients when they were insistent, and they wanted certain things, and she couldn’t accommodate them.

So I asked her, “What the most difficult problem you face?” Now, the answer surprised me. I thought she was going to say, “Well, sometimes I don’t say the right thing,” but that’s not what she said. Her answer was, “Sometimes, I really don’t know what to say. I just don’t have the words at all.”

That could be awkward. You know, on radio, they call that “dead air.” Can you imagine, you’re on the phone with someone, and then you say, “I just don’t know what to say.” So I helped her. We gave her great verbal skills. Now she’s confident. She’s happy. She’s relaxed. The whole practice is more relaxed, and, yes, the doctor is happy too.

So how do we do this? Let’s look at some verbal skills. The number one thing to keep in mind is empathy. Empathy means what? It means seeing it from the patient’s point of view. So that’s what we’re trying to do. We’re trying to see it from somebody else’s point of view because what’s the dynamic that we have?

We’ve got a patient on one side, in some cases, and staff on the other. Example. Somebody calls and says they want an appointment in the next couple of days. Well, there are no appointments in the next couple of days. The next appointment is actually a few weeks out. I’m not talking about somebody who’s in pain or has an emergency or anything like that. I’m talking about somebody who could wait, but they just choose not to.

So then, the staff person says, “Well, I’m sorry, our next available is three weeks out,” and then you have an insistent patient who is really trying to push and get in. So think about that. We’ve got a conflict. The patient wants to storm the gates and get past the gatekeeper, and the gatekeeper says, “No, no, no. We can’t have any more people today because we’re just too full.”

So how do we resolve the situation? A great thing to remember is that we’re talking about empathy. We’re talking about reducing tension. We’re talking about seeing it from the patient’s point of view.

A couple of great verbal skills would be to say things like this. “I understand. You know, let’s work together. I’m going to work with you, and together, we’re going to solve this problem.” And then, the patient relaxes a little bit. Another great verbal skill is, “May I make a suggestion?”

The patient says, “Well, if you’re going to work with me, if you’re going to help me resolve the situation, sure. What’s your suggestion?” The person says to the patient, “I know you don’t want to wait three weeks to come in. I understand, but let me make this suggestion.”

“Why don’t you take an appointment that’s three weeks out, just as a placeholder. We’ll put you down, put you on the schedule, and what that will do is it will get you into our system. And there’s going to be a change in our schedule over the next few weeks. I can guarantee you that.

“So when it happens, when we do have that change, that opening, I’ll call you. Now, I don’t know if it’ll be tomorrow or the next day or the day after that, but we’ll definitely call you. And then, you can move up and get a much closer slot.”

And that usually works out great because now, you’ve resolved the situation. You’ve lowered the tension. So what you’ve done is you’ve used some great verbal skills. So I hope you can take this to heart and use it.

Let me leave you with one other point. I’m using the example of somebody on the phone. This is not just for somebody on the phone. This is also for in-person interactions. This is for the assistant, the hygienist, the doctor, anybody who can say to somebody, “I’m on your side. I want to work with you. I understand, and make a suggestion, and then work it out with the patient that way.”

If you’d like some additional information, a copy of my Free Report, Three Mistakes Every Dental Practice Should Avoid, then just send an email to Those three mistakes, believe me, every dental practice should avoid them. You don’t want to make them. So just write to us at

I hope you’ve enjoyed this segment, and certainly, you can follow me on the web at This is David Schwab, and we’ll see you on the next episode of The Personal Report.

Topic for the next episode of The Personal Report: No Cost Team Motivation.  Click to subscribe.


Ultimate Secret of Practice Management

What is the ultimate secret of practice management? This blog is the final installment of my three-part series on how dental practices can learn from the phenomenal success of In the first part, I discussed the need for practice efficiency. The second lesson was about focusing on value, not price.

Another lesson from Jeff Bezos, founder of, is a relentless emphasis on customer service. As with the other great tips from Mr. Bezos, however, we need to adapt that lesson from amazon to the practice of dentistry.

Everyone knows that the patient comes first, and customer service is already stressed in most dental practices. I interpret the customer service lesson to be much more nuanced than a general desire to be polite and friendly. Customer service in a dental practice occurs not only because team members have an intuitive sense of how to treat people well, but because they are well trained.

The third—and most important—lesson we learn from amazon is the ultimate secret of practice management—a relentless emphasis on team training. Continual training gives the team the specific tools they need to provide outstanding customer service.

Here are three great ways to train your team:

1. Ask for examples. At a team meeting, ask everyone to give examples of great customer service they have experienced themselves. Don’t ask for service horror stories. Keep the conversation and the lesson positive. Ask what happened, why it was so memorable, and how great customer service has a lasting impact on one’s relationship with a company.

2. Set the standard. In my next blog, I will discuss “sticky situations” that occur in dental offices and how to resolve them. The doctor and office manager need to tell team members what to say in challenging situations.

3. Use outside resources. I have a Team Training Video Series and I also provide training by phone, Skype, and in person. Having a team coach is a great way to keep everyone trained, focused and motivated.

There is another great benefit of team training. It’s the reason team training is the ultimate secret of practice management. Team training feeds the other principles we have discussed in this series. With proper training, practice efficiency soars. Also, when team members have the right verbal skills, they are able to communicate value for the dollar and move past the cost objection.
There is a synergistic effect among the three principles because they are mutually reinforcing and underpinned by the ultimate secret of practice management: continual, relentless, purposeful team training.

Click to access the following resources:

Efficiency: Part 1.
Value, not Cost: Part 2

Price and Value Are Not the Same

Price and value are not the same! In my previous blog, I discussed lessons from founder Jeff Bezos. He identified three business fundamentals that are not going to change in the coming years. The first one is the need for speed, which I translated for the dental profession as the pursuit of efficiency.

Bezos says that customers never say they want higher prices, but the amazon model shows that people will pay more when they perceive value. The lesson for dentistry is not to run a race to the bottom by cutting fees in the face of competition. It’s all about value, not price.

Amazon plays the value game and plays it well. Consumer advocate and radio personality Clarke Howard cited a recent study:

“We all know Walmart is cheap and Amazon is convenient, right? But is that convenience worth paying up to 100% more to you? Because that’s the premium a new study says you’ll pay on select items when you choose to get them on” saves time. Why drive to Walmart or even shop online with Walmart when Amazon makes the customer experience so seamless and easy? Amazon is extraordinarily convenient. Consumers will pay for great service, and patients will pay for quality dentistry (a service) because they want it done right.

Your messages to your dental patients should be:

  • It’s never cheaper to do it twice. Our goal is to do it once and do it right.
  • We do not offer the cheapest dentistry. We offer a high quality service.
  • The dentistry we provide is a great value for the dollar.

Make sure all members of your team know the difference between price and value–something I cover in detail in my consulting work and lectures.

Even the most cost-conscious consumers want value, which means not spending any money unwisely.  People want to get the maximum return on their investment. It’s called value. That value is not the same as cost, but it does come at a price.

Next post: The third lesson from applied to dentistry.

Click here to read my blog on efficiency.

Click here for more info on the study referenced above.