Other ways to pay for dentistry.

This page discusses methods you might use to pay for dental treatment if you don't have insurance. This includes: A) Cash discounts. B) 3rd-party Financing. C) Discount dental plans.


1) Paying out of pocket.

If you're paying for your dental services on your own, don't overlook the possibility of making some type of financial arrangement directly with your dentist. Doing so may be beneficial for both of you.

This might include: A) A cash discount, B) Setting up a payment plan, or at least C) Prioritizing your dental work so your expenses are delayed or spread out for as long as possible.

a) Advance-payment discounts.

You might ask your dentist if they give a discount if dental work is paid for in a lump sum in advance.

Your offer may be turned down. But besides the obvious benefit this arrangement has for you, it can provide a number of advantages for your dentist too, so there's no reason not to ask.

1) Advance payments make less work for your dentist's employees.

With up-front payments, the workload for your dentist's front-office staff is reduced.

Each time you come in they won't have to ask you for a payment, nor will your account need any mailed statements or accounts-receivable monitoring. And, of course, there is no chance that your completed dental treatment will go unpaid.

2) Lump-sum payments may help to increase your dentist's productivity.

Patients who have already paid for their treatment in advance tend to have fewer broken appointments.

And during any one visit, if extra time presents itself the dentist can feel free to go ahead and get as much work done as possible rather than having to stay within their patient's budget.

3) Offering a cash discount might actually save your dentist money.

As explained here, the costs a dentist incurs with some 3rd-party dental financing programs can be substantial. And in comparison, offering a cash discount may save them money in the long run.

b) Ask your dentist if they'll offer you a payment plan.

Some dentists may consider making a relatively informal payment-plan option available to some patients.

You'd have to expect that this type of arrangement is only offered to patients with whom they've had a long-standing relationship and whose payment history has shown credit worthiness.

Here's how this type of arrangement might work.

  • The dentist asks for some portion of the dental treatment's total cost to be paid up front as a down payment.
  • This amount might be between one-third and one-half of the patient's total bill. The idea is that it covers a significant portion of the dentist's fixed costs, such as the procedures' dental laboratory bill and office overhead expenses.
  • The remainder of the cost is then budgeted out in monthly payments.
  • Especially in those cases where no interest is being charged, you would have to expect that the repayment time frame offered would be relatively short (just several months).

As whimsical as the idea of this type of arrangement may seem, when compared to those expenses imposed on a dentist by some 3rd-party financing programs (see below), this arrangement may prove to be relatively cost-effective. It's a way a dentist can boost their office's production at minimal expense.

c) Ask your dentist about prioritizing your treatment.

The dental work a patient requires is typically organized into what's termed a treatment plan. The ordering of the individual procedures within it reflects the urgency with which each needs to be performed.

Some procedures will need to be completed promptly, so to prevent further deterioration of the patient's teeth and/or gums. Others will be much less pressing and can be scheduled at a more leisurely pace.

Any dentist should be able to identify one or more breakpoints in their patient's treatment plan where the procedures listed begin a transformation from a state of comparative urgency to one of more moderate, less pressing need.

The idea is, once this point has been reached, the patient's dental visits can then begin to be scheduled less frequently, possibly even significantly so. As a result, their costs are spread out over a longer, more-affordable time frame.



2) Dental Financing.

A dentist will frequently have some type financing plan to offer to their patients. This is often via a third-party source.

Agreements - What to look for. / What to watch out for.

What are the usual selling points?

Here's a list of features that you'll likely find bundled into any commercial product.

  • A no-interest payment option.
  • Low monthly payment options.
  • No up-front costs.
  • No prepayment penalties.
  • No annual fees.
  • A quick decision about acceptance into the program.

If these features seem familiar, it's because they're usually about the same as those offered by the furniture or big-box store down the street.

Dental credit is an unsecured personal loan.

Financing dental work is a type of unsecured personal debt. You put up nothing as collateral. The work you've received can't be repossessed. And for these reasons, extending this type of credit is one of the riskiest types of consumer lending that there is.

To insure that they'll make a profit, a company will need to stack the terms of the agreement in a fashion that's as favorable for them as possible.

a) The interest rate.

You can expect that the interest rate involved will be comparatively high. It will usually run at least as high as your credit card. And, in fact, you may find that your card actually has a lower one.

Now, having said that, in some cases the interest rate can be zero.

Zero interest?

Some credit plans will feature a no-interest option. The terms may be such that (for amounts more than a certain minimum but less that a specified maximum) no interest is charged for the first one, maybe even two, years.

This can be a great deal for some patients, if they are capable of strictly adhering to the repayment terms of the agreement. But what happens if you don't make a payment on time, or if your balance isn't paid off in full before the end of the interest-free period? You better check.

A failure to comply may not only disallow your eligibility for the zero-interest feature but also trigger significant penalties. It's been estimated that as many as 20% of people participating in no-interest agreements (of all sorts, not just dental) fail to meet their plan's terms and incur these expenses.


Why not shop around?

With credit offered through your dentist's office, a part of what you're paying for is convenience.

But if you take the time to shop around, you'll probably find that your own bank, credit union or savings and loan can offer you terms that are more favorable.

Make your dentist a better offer.

If a dentist has chosen to offer financing, they are probably open to other types of deals too.

We haven't mentioned this yet but when you participate in the 3rd-party credit program they offer, they typically end up paying a fee (read below). And it can run on the order of 5 to 15% of the total loan amount.

Now, take a moment to think about what this implies. By their offering a plan, you already know that they are willing to discount the cost of their services. So why not consider making them a better deal?

Arrange for financing on your own (at your credit union, bank, etc...) and offer to pay this lump sum to your dentist, in advance, in return for a cash discount.

You pay less in financing charges, you get the cash discount and the dentist makes more money. Win, win and win.


The dentist's part of the deal.

To us, a very interesting part of this topic was learning about how the dentist fares in a third-party credit arrangement. It's not quite as favorable as you might think.

Did you know that the dentist usually incurs an expense?

You might expect that by being both the treatment provider and the middle-man for the transaction that the dentist would not only get the full amount of their patient's treatment costs paid to them up front but might also get some type of commission on top of that.

That's not the way things usually play out. In most cases, the dentist incurs an expense. And it can be on the order of at least 5% of the total amount financed and possibly even closer to 15%.

This cost is substantially greater than the 2 to 3% "merchant fee" that a dentist would be charged by a credit card company. (And this is why they might be inclined to offer a discount to those who pay for their treatment in-full in-advance, even when using a card.)

Why would a dentist agree to these terms?

The reason why dentists participate in 3rd-party arrangements is because of their bottom line. They're simply trying to keep their dental chairs filled with patients.

Promotional information produced by companies specializing in this field suggests that by removing the barrier of cost (by offering financing) a dentist can increase their income on the order of 25%.

There are other advantages for the dentist too. They get all of their portion of the money up front, usually just a few days after the agreement has been put in place. Determining the patient's credit worthiness (eligibility to participate in the plan) is turnkey and instant. And if the patient doesn't follow through and pay as promised, it's not the dentist's problem.

The fee that the dentist pays varies.

This part is interesting. Under different scenarios the dentist's cost of participating in these deals varies (significantly).

» Scenario #1: The patient chooses the interest-free option.

Some programs feature a no-interest option (see above). And while this can make a great choice for those patients able to comply with the strict repayment terms, it's the most costly scenario for the dentist.

If the patient isn't paying interest, the financing company has to get their money from someone. With this scenario, fees, on the order of 10 to 15% of the total amount financed, are deducted from the lump sum payment made to the dentist. Ouch.

» Scenario #2: The patient extends their financing over a longer time period, with interest.

Instead of the zero-interest option, a patient can opt for lower individual payments over a longer repayment period. The trade-off is that they will incur interest charges over the entire duration of the loan.

This scenario provides the more profitable situation for the dentist. Since the patient is paying interest, the fees imposed on them are reduced. They usually run on the order of 5% of the total amount loaned (which is about twice the amount they would pay to a credit card company if you charged your bill on your card).


Make sure it's a good deal for you, not just your dentist.

Don't be swayed by the fact that you've been offered financing by your trusted dentist. With the exception of some type of payment plan that's offered directly from them at little or no interest, what's being offered is a business deal and not just an act of goodwill.

The dentist has decided that the agreement offers advantages for them and that is why it's being offered to you. It may offer advantages for you too, but its terms need to be scrutinized.

Be skeptical of the sincerity of program endorsements.

Many 3rd-part programs boast of relationships (sometimes an endorsement) with various professional associations (including the Academy of General Dentistry, the American Academy of Periodontology, the American Association of Oral & Maxillofacial Surgeons, the American Dental Association and most state dental associations).

Don't be unduly influenced by this advertising. We would anticipate that these relationships are much more motivated by the financial concerns of the organization and its dentist members as opposed to the financial well being of patients.



3) Discount (referral) dental plans.

These plans are sometimes confused with dental insurance but fundamentally they're quite different.

With these types of products, the company that sells the program has contracted with dentists (a "closed panel" network) who have agreed to discount their fees in exchange for patient referrals.

Unlike an insurance company that assumes some financial risk, with this type of product the company simply acts as a matchmaker, matching dentists with patients. For this reason, they're sometimes called "referral" dental plans.


How do they work?

Most plans operate in the following fashion.

  • The member pays a (monthly or annual) membership fee. - This cost usually runs around one or two hundred dollars per year, depending on whether the membership is for one individual or one family.
  • The discount received is determined by a fee schedule. - This schedule lists all covered procedures and the amount that the participating dentist is allowed to charge for each (as payment in full for services rendered). The member's discount is simply the difference between this figure and the dentist's normal charges.

Note: All financial transactions related to the patient's treatment are between them and the dentist. The company that has sold the plan is uninvolved.


What you should know about these programs.

If you are considering joining a discount/referral network, here are some of the points and considerations, both positive and negative, that you should keep in mind.

1) Advantages

a) Ease of use.

As opposed to dental insurance, utilizing a discount plan doesn't involve filing claim forms or forms for predetermination of benefits. In most cases there are no deductibles, benefit limitations, or wait-period restrictions.

b) Cosmetic dental services may be included.

Some programs provide allowances for cosmetic procedures such as bonding or veneers. (To be sure, check the list of covered services before you join.)

c) The program may come bundled with other types of discount plans.

Dental plans sometimes come bundled together with others involving additional health-related fields (vision, pharmacy, hearing, chiropractic).

2) Disadvantages / Concerns

Watch out of off-plan "upgrades."

The financial risk associated with a discount program is shouldered by the participating dentist. In essence, they have agreed to do more work (accept the plan's referred patients) for less pay.

Having to incur this loss may create motivation for a dentist to encourage patients to opt for off-plan (full-priced) "upgrades" or "add-ons."

By no means are we suggesting that loss-leader or bait-and-switch tactics are the norm or to be expected. At the same time, in cases where coverage seems too good to be true, a patient should enter into the relationship with open eyes.


Features you'll need to evaluate.

As we looked through several discount plans, we noticed the following points that we felt some people might overlook.

» Pick the right type of program.

Plans tend to fall into one of two broad groups.

You'll need to evaluate your expected needs and purchase accordingly.

» Make sure that the types of procedures you require are included.

You'll need to know for certain that the types of treatment that you need are covered.

  • With some plans, if a particular procedure is not listed in its fee schedule, the patient still receives a discount. It's usually based on a flat percentage of the dentist's normal charges (such as 25% off).
  • With others, if it's not listed it's not discounted and you'll have to pay the dentist's full charges.

» Check for any non-standard or hidden fees that the dentist can charge.

  • Make sure that the dentist must accept the discount fee as payment in full.
  • Certain procedures (including crowns, bridges and full and partial dentures) involve dental laboratory expenses.

    Make sure that the discounted fee includes this laboratory cost. If it doesn't and it must be paid by you, ask if there is a discount for it too.

  • Watch out for plans that allow outrageous charges. We've found one where the dentist was allowed to tack on a "sterilization" fee.

» Does the plan provide for services from specialists?

Some of the dental procedures you'll require may need to be performed by a specialist. If so, check the plan's provider list to make sure that the kind you need is available in your area.

In some cases, their charges may be discounted differently than those of general dentists. For example, sometimes the discount is a flat percentage of the specialist's normal charges (such as, 25% off their usual fee).

» Other fee schedule considerations.

  • Make sure that the list of fees you see in the plan's promotional materials is the same one used in your area.
  • It's possible that the fee that a specific participating dentist is allowed to charge is different than what your plan suggests (due to an individual contract that they have entered into with the company).

    If you know which provider you plan to use, it would be best to contact their office directly and inquire about specifics.

» Some discount / referral plans do contain exclusions.

Some programs do have limitations. As an example, there may be an exclusion for work currently in progress. Consider the following scenario:

While not a member, you have root canal treatment initiated by a dentist who is a service provider for a plan. If you then join that program (during the time frame during which your tooth is being treated), you will not qualify for a discount for that procedure.

 

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