I work at the front desk of a dental office, and if a patient needs a large variety or a long stretch of work, we create “treatment plans” to let them know the scope and cost. These plans can be a hard sell if the patient has a small budget and, for that reason, poor insurance. The following conversation occurs over the course of several days, via both phone and email.
Patient: “This is a lot of money. Do I have to do all of it?”
Me: “If you truly desire, we can simply pull the affected teeth and not replace them. You’ll be, well, short a couple of teeth, but it’d save you a lot of money in the long run.”
Patient: “That’s fine, I’m turning seventy soon, I don’t have much time left. Okay, I want the teeth pulled only. What is this stuff about bone grafts? I’m not having the artificial implants.”
Me: “They are to promote healing in your jaw.”
Patient: “That seems like a waste of money. What’s wrong with me just having a hole in my jaw?”
Me: “Well…” *Explanation.*
Patient: “Okay, I will do that. Please schedule me for the extraction and the bone graft.”
Me: “Oh dear, it turns out we also want to apply a treatment to help your gums heal over the gap as well. I apologize for missing this. The treatment plan isn’t very well organized in terms of phases. I say this not to excuse myself but to explain myself. The gum treatment will cost you some more.”
Patient: “That seems like a waste of money. What’s wrong with me just having a hole in my gum where the tooth used to be?”
Me: “Well…” *Explanation.*
Patient: “That is a waste of money. Schedule me for the extraction ONLY, no healing afterwards.”
At this point, I stop to talk to my boss, the dentist. This doesn’t seem safe to me… but I have literally no formal dental training, so there could be important details I’m not aware of. Well, it turns out my instincts are accurate.
Dentist: “Tell her we don’t feel comfortable with the treatment as she wants it done. If she had PPO insurance, she could go basically anywhere, but she has HMO insurance and must be assigned to an in-network dentist like me; tell her that she should transfer to a different one.”
Me: “And if she disagrees? I’ve only been here for a year and a half, but I’ve already faced patients who intend to bully us into doing things their way, and I’m sure you’ve seen more like them.”
Dentist: “I have indeed. You’re doing a great job integrating all the exposition, by the way. The HMO network lets us decline patients. If you can’t reach an understanding with her, I authorize you to fill out the forms and have her transferred elsewhere. If the patient doesn’t trust us, there’s no future in the relationship.”
Me: *On the phone.* “[Patient], this is your dentist. I wanted to call you and let you know that we cannot schedule you as asked, and believe you should seek treatment elsewhere.”
Patient: “I can’t believe this! Why would you say such a thing?”
Me: “Well, without the grafts and the gum treatment, you’re essentially asking us to cut you open and then not sew you up afterwards.”
Patient: “This is America! I have that right!”
Me: *Doubting this is true.* “Regardless, WE do not feel comfortable performing such a procedure on you. That’s why we suggest you seek treatment elsewhere.”
Patient: “Why won’t you do it?”
Me: “The—”
Patient: “I don’t understand why you won’t do it. Why won’t you do it?”
Me: “The—”
Patient: “I don’t understand why you won’t do it. Why won’t you do it?”
Me: “The—”
Patient: “I don’t understand why you won’t do it. Why won’t you do it?”
Me: “Would you like me to tell you? I’ve been interrupted every single time.”
Patient: “Okay, why?”
Me: “Because we don’t feel comfortable opening you up and then not–”
Patient: “The other stuff makes the price 6 times higher! You’re just trying to get more money from me!”
Every for-profit business exists to make money, and we’re especially concerned about HMO patients like this one, as we’re contractually obligated to lose money on some of them. That said, I know whether someone is ready to have a logical conversation. Besides, I have better ways to spin it.
Me: “Our primary concern is your health. To repeat, we don’t feel comfortable performing surgery on you and then not applying the necessary measures to help you recover. If that is what you want, you should seek another dentist. We are not the kind of office that does a cut-rate job just to save money.”
Patient: “You only care about money! Those other offices will let me save the money, but you won’t?”
Me: “Well, if that’s the case, I think we’re in agreement that you’d be happier at one of those other offices.”
Patient: “No, they only care about money!”
My boss, the dentist, has taken a seat next to me. The patient’s volume is such that he can hear them clearly. I know he has come to offer back-up if I need it; but I can also see the self-congratulatory grin for having me on hand to tackle it for him.
Me: “That’s correct. WE care about your health. Which is why we have proposed additional measures that–”
Patient: “I don’t want those! Those are a waste of money!”
Me: “I’m sorry, but I think it’s time to bring this conversation to a close. It’s clear we cannot come to an agreement on the best way to move forward. To repeat, I think everyone will be more satisfied if you seek treatment elsewhere. I’m going to have you unassigned from our practice, and I wish you great fortune in finding a dentist that is more to your satisfaction.”
The patient is still going when I hang up. I then get an email from her claiming that she doesn’t consent to being reassigned. Alas, the paperwork was filed within five minutes of the end of the call.
