Ep. 89: The Wrong Approach to Presenting Treatment
Recently we’ve found that a surprisingly high number of dentists are making a big mistake in their treatment presentations—and in addition to harming your case acceptance, it can upset patients and lead to future problems. So this week, Jeff talks about this problem and why you may need to change your approach to presenting treatment.
Links:
The MGE Communication & Sales Seminars - https://mgeonline.com/mge-communication-and-sales-seminars
Free Consultation - https://www.mgeonline.com/free-practice-analysis
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Questions From This Episode
Should I only present the treatment insurance will cover, or the full treatment plan?
Always present the full treatment plan, regardless of what insurance happens to cover. The patient's job is to decide how they want to handle the cost, but that decision only belongs to them if they actually know what's wrong in the first place. Presenting only the insurance-covered portion quietly takes that choice away from them.
Why are so many dentists still hesitant to present a patient's full treatment plan?
Usually fear, followed by apathy once that fear becomes a habit. A doctor gets an upset reaction from a patient once or twice, decides that can never happen again, and starts under-presenting treatment to avoid future conflict. Over time that shift stops feeling like a compromise and starts feeling like just how the practice operates.
If a patient gets upset about their treatment plan, does that mean I should stop presenting full treatment to everyone?
No. Roughly 20 percent of patients in any practice are going to be difficult regardless of what you do, that's a fairly consistent pattern, not a sign you're doing something wrong. The mistake is letting one or two negative reactions from that smaller group reshape how you treat the other 80 percent, who are generally reasonable and, more often than not, appreciate being told the truth.
Does a patient saying they only want what insurance covers mean they don't care about their teeth?
Not usually. In most cases it just means they haven't yet grasped why the treatment matters, not that they're indifferent to their own health. Genuine indifference exists in a small number of patients, but treating every insurance-focused comment as a lack of caring misses the more common explanation: the value of the treatment simply hasn't been communicated clearly enough yet.
What happens to a practice long-term if it only presents what insurance covers?
Patients end up with real, undiagnosed or unaddressed problems they were never told about, which tends to surface eventually and generate real anger, exactly the kind of experience that drives negative reviews. It also quietly limits the practice to lower-value, insurance-driven care, and over time turns dentistry from the kind of work a doctor actually wants to do into something closer to routine, unfulfilling labor.
Episode Transcript
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You're about to present a treatment plan to a new patient. You've completed a thorough initial oral exam, taken appropriate X-rays, maybe a full mouth series, and have a solid handle on their chief complaint. They have a substantial treatment plan, not enormous, but substantial: some scaling and root planing, two root canals, six crowns, and a few smaller composites, totaling around 13,000 dollars.
Your financial coordinator has reviewed the treatment plan alongside the patient's insurance benefits and found a 1,500 dollar yearly maximum, 300 of which already went toward the new patient exam and X-rays. So there's about 1,200 dollars left toward this 13,000 dollar plan. Now you have to actually present it. What do you do?
My flash answer: of course you present the full treatment plan, and the patient's copayment ends up being 11,800 dollars. That's what I'd say, and it's what essentially every MGE client would say too. You found something, you tell the patient what you found, that's simply how it works. But what still surprises me is how many doctors don't do that, instead presenting only what insurance covers, or presenting part of the plan now and the rest later.
That's what I want to talk about this week: why you should almost always present a patient's full treatment plan, and why nothing, including insurance coverage, should get in the way of that relationship between you and your patient. My name is Jeff Blumberg, and I'm your host.
Full disclosure, this episode wasn't originally on my content calendar. What prompted it was a conversation with a client who'd just purchased a practice from a doctor whose entire model was insurance-driven, along with a few other client conversations, and Sabri mentioning she's still running into this with newer clients. I'd heard versions of this years ago, doctors telling me, I don't present full treatment plans, but I genuinely thought that had mostly faded from the profession by now. Maybe I'm just talking to the right mix of clients, but it clearly hasn't, and I felt this needed to be said directly.
This doesn't just affect the treatment you're providing and the help you're giving patients, it also quietly erodes goodwill in your practice. Here's an example. I was talking with this client who'd just bought a practice where the prior doctor's policy was simply, we only do what insurance covers, full stop. Day two in the new practice, a patient comes in from the old doctor with a cracked tooth. I didn't get the full clinical picture, it sounded like a partial crack rather than something requiring extraction, but the patient explained that it cracked while flossing, which is essentially impossible on a healthy tooth.
Sure enough, there was a pre-existing defect visible in the patient's old X-rays. I don't know exactly how the new doctor handled that conversation, but when she explained that flossing alone couldn't have caused that kind of crack, the patient's immediate reaction, and remember, they'd already walked in upset, was: why didn't the doctor tell me? The reason they were never told wasn't malicious, it likely just wasn't covered by insurance, or they'd used up their benefits, but it also simply wasn't how that practice operated. In an effort to avoid an uncomfortable conversation, that office ended up with a genuinely upset patient instead, which is exactly the kind of thing that erodes goodwill over time.
From what I've seen over the years, this pattern is usually driven by two things: fear, and eventually apathy. Let's start with the fear piece. Sabri was recently meeting with a newer client, brand new to MGE, who was doing exactly this with new patients carrying substantial treatment plans, holding back the full picture up front. When asked why, the answer was they didn't want to scare the patient or come across as only caring about money, they wanted the patient to get to know them first and see they were good people.
Here's an imperfect but useful analogy. Say your car is knocking and shimmying, genuinely bothering you, so you take it to a mechanic. They inspect it and find five separate issues, roughly 5,000 dollars to fully repair. But since you're a new customer, they worry that number might scare you off entirely, so they only mention and fix one issue. You drive off, maybe the knocking's gone, but it's still shimmying. Was that actually fixed? Why would you go back to that shop? You went there to restore full function. Dentistry works the same way, you're there to restore health, function, and aesthetics, to create genuinely healthy patients. Trying to avoid scaring or upsetting a patient by withholding part of the picture often produces exactly the upset reaction you were trying to prevent, just delayed.
This is very likely part of why roughly 30 percent of negative dental reviews trace back to the treatment presentation and acceptance process, something I've mentioned before, in seminars and on this podcast. Often the pattern is: patient walks in believing everything's fine, gets told otherwise, and reacts poorly. There are real techniques for softening that initial shock, dropping small hints during the exam itself, noticing aloud that a cusp seems worn or a tooth feels different, showing them on camera or having them feel it themselves, gently foreshadowing that something may be off before the full presentation.
But there's an equally damaging version on the other side: reviews that read, I never had dental problems, then this office told me I needed 8,000 dollars of work, so I went back to my old dentist. You've probably seen one of these, maybe even received one. In a lot of these cases, the old dentist simply wasn't disclosing problems, maybe not routinely, but often enough that it becomes a real pattern with real consequences.
Here's how I'd frame this for any doctor: you're the technician here. You're looking in my mouth and determining what's actually needed to restore my health. Whatever I say back to you along the way is simply information about who I am as a patient, not a directive on how to diagnose or present. If I tell you I only want what insurance covers, that just tells you I may need more time and a different communication approach to bring me around, it doesn't make me a bad person, and it definitely shouldn't change what you tell me is actually wrong.
I've heard people describe patients who decline treatment, or want to wait, or spend money elsewhere instead, as simply not interested in their teeth. That's usually not accurate. More often it means they haven't genuinely grasped why the treatment matters yet. That's the real disconnect: you've explained something thoroughly, you personally would accept the plan in their position, and then they say something that seems to make no sense from where you're standing, wanting to go on a cruise instead, say. It's natural to feel a bit frustrated by that. But in almost every case, it's not that they don't care, it's that the significance genuinely hasn't landed for them yet.
So we come back to this fear of telling people what they actually need. If you've ever told me you avoid full disclosure because you're worried about a negative reaction, my first question would be: has that actually happened to you? You might say yes, I told a patient they needed 16,000 dollars of treatment and they got very upset. Fair enough. My next question: how many times has that actually happened, specifically with new patients you didn't yet have an established relationship with? Really think about that number. It's very likely small enough to count on one hand.
Here's where it goes wrong. It happens once, maybe twice, and you decide, I can never let that happen again, so I'm going to change how I operate entirely, and start under-presenting treatment across the board. A few things worth knowing here. Roughly 20 percent of the patients who come through any practice are going to be genuinely difficult, that's a fairly consistent pattern, not something specific to your location or patient base, even if it feels higher some days. Which means about 80 percent are reasonably easy to work with, some more enthusiastic than others, but fundamentally reasonable people.
But a couple of rough encounters with that smaller 20 percent can start to color your perception of everyone. It's an odd but very human pattern: see 20 patients in a day, 19 of them pleasant or at least perfectly civil, one of them genuinely nasty to you and your front desk, and guess who you're talking about at dinner that night? Not the 19 good interactions, the one bad one. That's just how memory works.
Where it actually goes wrong is when you start reshaping your entire approach around that smaller, difficult minority. Say a patient flatly insists they only want the cheapest option or exactly what insurance covers, and won't budge regardless of what you explain. That patient may simply not be the right fit for your practice, and that's genuinely fine. You can't run an apple juice factory and also stock oranges. You want patients who are actually invested in their own health, and if your practice is built around genuinely restoring health, function, and aesthetics, patients who share that value will generally stick around, while ones focused purely on lowest cost will shop elsewhere anyway, which honestly serves everyone better.
You can't please everyone, and trying to design your entire practice around the small percentage who are never going to be satisfied is where doctors go wrong. It's roughly one in five, not four in five. Most patients, if treated honestly and clearly, will respond reasonably even if they don't move forward with everything immediately.
The uncomfortable part of all this is that this pattern is really driven by fear, fear of losing patients specifically, even if it doesn't feel like outright fear day to day. Left unaddressed long enough, that fear settles into something closer to apathy. Not indifference exactly, more a quiet sense that pushing further simply isn't worth the friction anymore. A handful of pushback conversations about insurance coverage accumulate, and eventually a doctor just defaults to, we only do what insurance covers, full stop, as an operating philosophy rather than a rare exception.
Once that becomes the default, the actual practice of dentistry tends to stop feeling fulfilling. Nobody goes to dental school specifically to only perform whatever a given insurance plan happens to authorize. Left unchecked, a doctor stops functioning as the clinician determining what a patient genuinely needs, and instead settles into a much narrower, less satisfying version of the job.
That same client who'd purchased the insurance-driven practice found something telling early on: a real backlog of patients who clearly needed periodontal therapy but were sitting on standard six-month recalls with zero periodontal treatment ever offered. Once the new team started actually raising it directly, we need to do some scaling here, here's what we're seeing, patients said yes. They were genuinely receptive. Patients aren't dentists themselves, they came to you specifically because they want help, and in most cases, they're far more receptive to hearing the truth than doctors expect.
So my actual recommendation: run whatever exam process you run, arrive at whatever treatment plan your clinical judgment calls for, that part is entirely yours, I wouldn't presume to influence it even if I were a doctor myself. Figure out what the patient genuinely needs, get a sense of their current understanding, take the time to actually explain it clearly, and tell them the real cost. Some patients can afford it outright, some will need to phase treatment over time simply because the full amount isn't realistic for them right now, and that's fine too.
What's genuinely surprising is how often patients respond well to this. They came to you specifically for help, you're trying to actually help them, and there's an immediate, natural alignment there once it's communicated clearly. Most patients, especially as your communication and sales skills improve, and I'll mention the MGE Communication and Sales Seminars here, along with our professional sales training on DDS Success, links on the episode page, will move forward once they genuinely understand what's actually being recommended and why.
When you consistently tell patients exactly what they need, a few genuinely good things happen. You get to do the kind of dentistry you actually find meaningful. Your practice collects more, which matters practically. But most importantly, your patients end up genuinely healthier, which is really the entire point of any of this.
So that's what I wanted to cover this week, mainly because I was surprised this is still happening as often as it apparently is. If you've been letting a patient's insurance coverage, or a fear of upsetting someone, shape how much of their actual treatment plan you present, I'd ask you to stop. Just tell them what they need, it's genuinely that straightforward. They generally won't bite. Some may be a little taken aback simply because nobody's told them clearly before, and in most of those cases, a little patience and understanding resolves that entirely.
And occasionally you'll run into a genuinely difficult patient who isn't interested in hearing it regardless of how it's delivered, in which case, that's fine too, they may simply not be the right fit for your practice. That's exactly why dental practice acts include provisions for discharging a patient when necessary, and it's far better to identify that early than partway into a large treatment plan.
Shorter episode this week, but I felt this was genuinely worth addressing directly. I hope it helps, links are on the episode webpage. If you have any questions, you can always reach me directly at jeffb@mgeonline.com. If you want to learn more about MGE, visit us online at mgeonline.com or call 800-640-1140. Have a great week, and I'll talk to you at the next episode.