EP 204: Patient Disapproved For Financing? Here’s How to Save the Case
Ever had a patient excited about treatment—only to lose them when financing falls through? In this episode, Jeff Blumberg reveals a step-by-step system to prevent denials from killing your case acceptance, keep patients motivated, and ensure they still get the care they need.
The MGE Communication & Sales Seminars - https://www.mgeonline.com/abc
Listen to full episode :
Have a question for Jeff?
Fill out the form and he will get back to you.
Questions From This Episode
What should happen before a patient ever applies for financing, to reduce the odds they end up denied and discouraged?
A proper treatment presentation with real time built in, confirming the patient actually wants the treatment before the fee is even discussed. If a patient's answer to do you want to do this isn't a genuine yes, that needs to be resolved first, since applying for financing on treatment someone isn't fully committed to sets up exactly the discouraged reaction that ends a case.
Why is it a mistake to always default a patient to a financing company instead of asking how they'd normally pay?
Because patient financing typically costs 2 to 15 percent in merchant fees, compared to roughly 1.8 to 3 percent for a standard credit card, a meaningful difference on a large case. Asking the patient how they'd normally handle a purchase like this also gets them actively involved in solving the payment question themselves, rather than having a solution handed to them before they've had a chance to consider paying directly.
What should you actually do if a patient's financing application gets declined?
First check whether the patient mentioned an alternative payment method earlier, like a credit card, before moving to financing, and revisit that option directly. If not, and other financing companies exist that better fit their credit profile, apply through one of those. If financing options are exhausted, a co-signer is the next step, and only after all of that is exhausted should the treatment plan itself be reconsidered or phased.
Does the median income in a practice's area actually determine whether high-end treatment is viable there?
Not nearly as much as commonly assumed. One example cited is a client doing close to 10 million dollars a year, four to five million of that in full arch cases, in an area with a median income under 70,000 dollars, meaning many patients are investing more than half a year's income in a single case. Patient willingness and desire for the outcome matters far more than local affluence.
What steps come before considering a co-signer or phasing down the treatment plan?
Confirming whether the patient can pay directly, by credit card or a workable payment amount, and if not, applying with a financing company genuinely suited to their credit profile and monthly payment capacity, rather than defaulting to whichever company is used for every case regardless of fit. A co-signer and treatment phasing are later options, used only once direct payment and financing have both been genuinely explored.
Episode Transcript
-
Before getting into this week's topic, a quick correction. An astute listener caught an error from episode 200, where the dates for sending second and third notices in the collection program discussed didn't match the accompanying handout. The handout itself has the correct dates, so if you're following that, you're in good shape. Thank you to that listener for the catch, mistakes happen, and I appreciate being kept honest.
Now, this week's topic. Picture this: you've presented a treatment plan, the patient wants to proceed, and heads off with your treatment coordinator to work out payment. During the presentation, when the patient hesitated at the cost, you assured them there were several payment plan options that would make the treatment affordable. Later that day, you check in with your treatment coordinator expecting to see that patient in the chair, only to learn they were declined for financing, felt discouraged about it, and said they'd look around for a less expensive option elsewhere.
Fast forward to the end of the month, and your numbers aren't where you expected given how much treatment you know you presented. When you ask your office manager or treatment coordinator, the answer comes back: too many financing denials. Frustrated, you start wondering if the real fix is finding higher quality new patients, or in more extreme cases I've genuinely seen, considering relocating the entire practice to a more affluent area, since patients locally just can't afford quality treatment.
Does any of this sound familiar? You're not alone, we've heard some version of this story consistently for 25 years. So if your practice isn't in an area with a median income above 90,000 to 100,000 dollars, are you simply out of luck? Not at all. Some of our most successful clients operate in genuinely ordinary, blue collar working class areas. Area income and individual patient affluence can play some role, but they are not the primary driver of practice success or growth.
So what should actually happen in that opening scenario? What do you do when a patient is denied financing, and how do you save that case and get more patients the treatment they genuinely need? That's what I want to cover this week. My name is Jeff Blumberg, and I'm your host, and I've structured this into three parts: what to do before a patient ever applies for financing, what to do during the application process, and what to do if the patient is denied.
Let's start with the lead up to financing, since a few specific steps here can prevent this entire situation from happening in the first place, or at minimum keep a denial from becoming a dead end.
First, the case presentation itself. We cover this in much greater depth at the MGE Communication and Sales Seminars, which I've been one of the main lecturers on since 1998, we've worked with tens of thousands of dentists and their teams on this, and the average client sees close to a 300,000 dollar increase in the first year. It genuinely teaches you how to get patients to want what they need, link on the episode page.
But at a basic level: make sure you actually have adequate time to properly present a treatment plan representing a genuinely large decision for that patient, 5,000, 7,000, 10,000 dollars relative to their income. If you don't have that time same day, bring them back rather than rushing it, but always ensure adequate time exists, and that applies to you personally as the doctor, not just your treatment coordinator.
Build genuine rapport, clearly explain what you found, and make it tangible, an intraoral camera showing the actual missing cusp or visible decay does far more than an X-ray alone. Explain what you want to do to fix it in plain language, not a string of clinical terms, show them what an implant or crown actually looks like using a model or an old lab case if you have one. Cover why addressing it now matters.
Once they seem to genuinely understand, confirm they actually want to move forward before discussing fees at all. You can ask directly: do you understand what's going on here, do you want to do this? If the answer isn't a wholehearted yes, if it's more of an I guess or maybe, go back and make sure they genuinely understand the treatment and why it matters first. Don't move into fees until real interest is established, otherwise you end up arguing about money for something they were never actually sold on.
Once genuine interest is confirmed, state the fee directly: this treatment plan is 10,000 dollars, we expect insurance to cover about 1,500. Reactions will vary, but say the patient responds with, wow, that's a lot, I don't know how I'd manage that. A simple, natural follow-up: how would you normally handle something like this? They might say they typically wouldn't, or that they'd put it on a credit card. Ideally your treatment coordinator has been present for the entire conversation from the start, so this flows naturally as one continuous discussion rather than a handoff.
This is actually where a lot of practices go wrong from the very beginning. Patient financing is genuinely valuable, it makes treatment accessible that simply wasn't available to patients twenty years ago, and there's no shortage of options today, with new ones entering the market constantly. But it's a tool with a specific use, not a default first move.
What I commonly see instead: a treatment coordinator instructed to always run every case through financing company X, without ever giving the patient the option to simply pay directly. The problem is that financing typically costs 2 to 15 percent of the fee in merchant fees, versus roughly 1.8 to 3 percent for a standard credit card. On a 10,000 dollar case, that's the difference between eating 300 dollars and eating up to 1,500. If the patient can simply put it on their own credit card, that's usually the better outcome for the practice, and often the simpler one for the patient too.
So if the patient says they'll just put it on their card, let them, send them off with the treatment coordinator to finalize it. Before they leave the room, whether financial arrangements are fully settled or not, it's worth planting a scheduling seed to help your front desk. If you prefer doing certain procedures in the morning, ask your treatment coordinator when your next morning slot is, then ask the patient directly if they can make that time. That's not locking them into the schedule yet, but it helps maintain control over when specific types of procedures get produced.
Now say instead the conversation continues: the patient doesn't want that much sitting on a credit card, or can only put 3,000 toward an 8,500 dollar balance, and asks about payment plan options. This is where financing genuinely comes in. The next thing to establish is how much they can realistically pay monthly, since that determines which financing product actually fits. If they could pay off the balance in six months, there's no reason to place them on a two year plan with more fees attached long term. If they mention a specific monthly amount that doesn't match any option you offer, it's worth a brief conversation, could they manage 150, 200, 400 dollars a month, whatever aligns with your actual available financing products.
As the doctor, you don't need to know every technical detail of each financing company, but you should have a working sense of which product tends to fit which situation. There are countless options now, CareCredit, Cherry, Alphaeon, Proceed, Sunbit, and increasingly, buy-now-pay-later platforms like Affirm and Afterpay expanding into healthcare, often with a simple link a patient can complete right on their phone. None of these companies have any relationship with me, just naming what's out there.
My general recommendation is to be set up with as many relevant financing options as you can reasonably manage. The upside of having several is genuine flexibility across different credit profiles, you don't want just one product that only serves patients with excellent credit, you want coverage across high, medium, and lower credit tiers too. The tradeoff is that relying heavily on one or two providers can sometimes earn better merchant fee terms over time, so there's a balance to strike, but the priority is always having a workable path for the patient in front of you.
Once you've established roughly what the patient can pay monthly, send them off with the treatment coordinator, confirm scheduling, and let the financing conversation continue privately. The treatment coordinator's first step should be discussing credit specifically, and this needs to happen somewhere genuinely private, an operatory or treatment planning office, not at an open front desk where other patients might overhear.
Knowing roughly where a patient's credit stands, strong credit with little debt, moderate credit with more debt, or something like an active bankruptcy, helps determine which financing company to apply with first. Credit quality can affect what a patient ultimately pays, though not always, and if someone is genuinely committed to the treatment, there's usually a workable path. The goal is having enough financing tools available that a real fit exists, based on credit profile, desired payment timeline, and the total amount being financed.
When you actually apply, it's worth being upfront with the patient: approval decisions aren't always predictable, plenty of people get approved when you'd expect a decline, and plenty get declined when you'd expect approval. Framing it that way upfront, so a denial doesn't feel like a personal verdict, helps keep the conversation constructive if the news isn't good.
So say the application comes back denied. If a second financing option exists that better fits their profile, apply there next. If earlier in the conversation the patient had mentioned an alternative, like putting part of it on a credit card, that's worth revisiting directly: given what we discussed earlier, would putting this on your card make sense as a backup here?
There's a broader principle behind this approach worth mentioning. Patient financing became widely available roughly in the mid-2010s. Before that, options were far more limited, typically a small local finance company or a credit card. Once financing became ubiquitous, a lot of case presentations shifted: the moment a patient reacted to cost, whoever was presenting would immediately jump to, don't worry, we have financing options, without ever asking the patient how they'd actually want to handle it themselves. That subtly took the patient out of actively solving the problem alongside you. Asking directly how they'd normally pay keeps them genuinely engaged in finding a solution, and a patient who's genuinely motivated will generally find a way to make something work.
If financing gets declined and there's no remaining alternative payment method or financing option that fits, the next step is a co-signer, a sibling, parent, or similar, who may need to come in and speak directly with the doctor depending on the financing company's requirements. It's more involved than a simple credit card payment, but the goal remains getting the patient the treatment they genuinely need.
If you've gone through all of this, direct payment, financing matched to the patient's actual credit profile, a co-signer option, and still can't get approval, here's some perspective: the overwhelming majority of patients, in our experience, around 99 percent, end up finding a workable path somewhere in this process, whether paying directly, getting approved, or securing a co-signer. The remaining 1 to 2 percent are genuine outliers.
For that small remaining group, the path depends heavily on the specific case. If accommodating the patient means meaningfully changing the treatment plan itself, say from a 10,000 dollar case down to what a patient can realistically manage, that decision needs to involve the doctor directly, since it may mean phasing treatment based on clinical priority. In some genuinely extreme cases, severe decay requiring extensive same-day treatment, phasing isn't clinically realistic, and the practical option may be referring the patient to a low-cost clinic, dental school, or handling it as a deliberate charity case if that's something your practice chooses to do. Those situations should be rare, and ideally a conscious choice on your part rather than something forced by an unresolved financial situation.
Beyond that small group of outliers, if you've been thoughtful throughout this process, most patients end up with a workable path, some financing products today are designed to approve nearly everyone who meets basic criteria, sometimes with a modest down payment required for lower credit profiles. I'd recommend researching the full landscape of options available, well beyond just the most commonly known names, to have genuine backup tiers ready for patients who don't fit conventional financing criteria, without losing a case the patient genuinely wants to move forward with. Ultimately, patient willingness matters more than almost anything else in this equation.
It's a common but inaccurate assumption that you need an affluent area to do high-end treatment. I have a client doing close to 10 million dollars a year, 4 to 5 million of that specifically in full arch cases, in an area with a median income under 70,000 dollars, meaning many of his patients are investing more than half a year's income into a single case. The idea that your area's income level single-handedly determines your practice's ceiling simply isn't accurate. I've also seen practices relocate to more affluent areas expecting that alone to solve their collections issues, only to be disappointed, because genuine patient willingness and desire consistently matters more than local affluence.
So the overall message: a financing denial doesn't have to become a dramatic, case-ending moment. If the groundwork earlier in the process is handled well, confirming genuine interest before discussing fees, asking how a patient would naturally prefer to pay, matching financing options to their actual situation, a denial becomes just one more step to work through, not the end of the conversation. What you do before the application is genuinely the most important part of all of this.
I hope this helps. I'd definitely recommend the Communication and Sales Seminars if you want to strengthen how you present treatment overall, link on the episode page. If you have any questions about anything covered here, feel free to email me directly at jeffb@mgeonline.com. Have a great week, and we'll see you at the next episode.