The Hidden Cost of Poor Financial Communication in Dentistry (Why “We Told Them” Is Not the Same as “They Understood”)

Sarah Beth Herman
Apr 16
7 min read

By Sarah Herman, CEO of Dentistry Support® | No Silver Spoons Podcast

This Is Where Practices Lose Trust

It’s not clinical skill. It’s not technology. It’s not even case acceptance. It’s how money is communicated.

Because here’s the truth most people don’t want to say out loud:

Patients don’t leave because of dentistry. They leave because of how they feel when money is handled poorly.

And the worst part? Most teams think they’re doing it right. They explained it, printed it, highlighted it, and had the patient sign it. So in their mind, it’s handled—but that doesn’t mean the patient actually understood anything.

This free training is about that gap: the difference between saying something and making sure it lands. Because that gap is where problems start.

The Problem: Communication vs. Understanding

In most dental offices, financial conversations are treated like a checklist.

You present the treatment. You show the numbers. You point to the estimate. You get a signature.

Done. But let’s be honest for a second.

Have you ever signed something without fully reading it? Have you ever nodded along in a conversation because you trusted the person talking? Have you ever assumed something was covered because it had been before?

Patients do that every single day.

There’s research behind this too. Patients don’t retain most of what they hear in medical settings, especially when they’re stressed or overwhelmed. And let’s not pretend people are relaxed when they’re sitting in a dental chair talking about treatment and money.

So when a team says, “We told them,” what they usually mean is:

“We said the words.”

That’s not the same thing as making sure the patient understood them.

Why “They Signed It” Doesn’t Protect You

This is one of the biggest mistakes I see.

A situation goes sideways and the response is:

“Well, they signed it.”

That might protect you on paper. It does not protect the relationship.

A signature means they acknowledged something was presented. It does not mean they processed it, agreed with it, or even realized what it actually meant for them financially, and patients don’t think in terms of documentation.

They think in terms of experience. So when something comes up later and they’re surprised by a balance, they’re not thinking:

“Well, technically I signed this.”

They’re thinking:

“Why didn’t anyone make this clear to me?”

That’s where trust starts to break.

What Happens to Patients in These Conversations

You have to understand the environment patients are in when these conversations happen.

They’re already dealing with:

Anxiety about treatment
Fear of pain
Uncertainty about what’s needed
Embarrassment about their oral health

Now add money on top of that.

When people are in that state, they are not processing information at a high level. They’re relying on trust, tone, and assumption.

There’s actual research that shows when people are under financial stress, their decision-making gets worse. Not because they’re irresponsible, but because their mental bandwidth is already being used up. So when a patient says yes in the moment, that doesn’t always mean:

“I fully understand and accept this.”

A lot of times it means:

“I trust you and I’m going with what you’re telling me.”

If that trust is misplaced, the fallout is immediate.

The Most Common Breakdown: Waiting Until the End

Here’s where things really start to fall apart in most offices.

Treatment happens first. Money gets addressed after.

That is one of the biggest operational mistakes you can make. Because once treatment is done, the patient is no longer making a decision. They’re reacting to a situation and if that situation is a number they didn’t expect, you’ve now created tension that didn’t need to exist.

There’s a simple principle that applies here:

Clarity before treatment prevents conflict after. If there is a balance, it needs to be clearly stated before anything starts.

Not implied. Not assumed. Not buried in paperwork. Clearly stated.

Because once the patient is sitting at checkout hearing a number for the first time, you’ve already lost control of the conversation.

The Mindset Problem No One Addresses

There’s another issue here that doesn’t get talked about enough.

A lot of front office teams have gotten very comfortable explaining why something can’t be done.

You hear things like:

“That insurance never approves that”
“Appeals don’t work”
“There’s nothing we can do”

And over time, that becomes the default response but here’s the problem with that. Hard is not the same thing as impossible. just because something didn’t work once doesn’t mean it never will. Just because it takes effort doesn’t mean it shouldn’t be done.

Appeals get approved every day. Narratives can be improved. Documentation can be stronger. Alternatives can be offered.

But that only happens if someone actually tries. When teams stop at the first obstacle, the patient ends up paying for that decision, whether they realize it or not.

This Is a Leadership Issue, Not Just a Front Desk Issue

It’s easy to point at the front office and say this is their problem.

It’s not.

This is a leadership issue.

Because leadership sets the standard for:

How conversations are handled
How problems are approached
How patients are treated when things go wrong
How accountability shows up

When a situation escalates, you find out very quickly what kind of systems are actually in place. Do people slow down and take control? Or do they react and start defending themselves? Do they focus on solving the issue? Or proving they followed the process?

Those are two very different cultures.

And patients can feel the difference immediately.

What Needs to Change

If you want to fix this, it’s not complicated, but it does require discipline.

Here’s what actually works:

Make patients repeat it back. Don’t ask, “Do you understand?” Ask them to explain what they’re responsible for. That’s how you know it landed. Involve the right person. If someone else is paying, you talk to that person. Not just the patient in front of you. Collect upfront when there’s a balance. Not at the end. Not after treatment. Upfront.

A bird in the hand is worth two in the bush. You don’t wait and hope it works out later.

Stop defaulting to “no.” If something is denied, look at it again. ask questions. explore options. Don’t assume the first answer is final. Slow things down when they escalate. The moment emotions rise, the goal is no longer speed. It’s control and clarity.

None of this is complicated.

But it does require intention.

Why This Matters More Than You Think

Most offices think their systems are fine because they haven’t had a major issue. But these problems don’t show up gradually. They show up all at once.

A patient is confused. A conversation escalates. A team gets defensive. And suddenly, something that could have been handled in two minutes turns into a situation that damages the relationship.

And when that happens, it doesn’t matter how beautiful your office is or how great your clinical care has been.

That’s not what the patient remembers.

They remember how they were treated when something went wrong.

What You Don’t See Coming

Every practice has a moment like this waiting to happen.

It’s sitting in:

An unclear financial conversation
A note that wasn’t followed
A denied claim that wasn’t revisited
A patient who nodded but didn’t understand

And it doesn’t feel like a big deal until it is.

Until it turns into a situation you can’t walk back.

What’s Coming in Episode 119

In Monday’s episode of the No Silver Spoons Podcast, I’m going to walk you through a real situation that brings all of this to life.

This isn’t theoretical.

This happened.

And it happened to my own family.

The episode is called:

“They Wouldn’t Let My Family Leave Until They Paid $1,460.”

And what you’ll hear is not just what went wrong.

It’s how fast it went wrong.

Because this wasn’t a bad office.

This wasn’t poor clinical care.

This was a breakdown in communication that turned into something no patient should ever experience.

If you think your systems are solid, listen to this episode.

Because the gap between “we explained it” and “they understood it” is smaller than you think.

And the consequences are bigger than most practices are prepared for.

About Dentistry Support®

Dentistry Support® works with dental practices to improve the part of the business that most offices struggle with but don’t always know how to fix—operations, communication, leadership, and financial systems.

We help teams get clear on how they present treatment, how they talk about money, how they handle insurance, and how they create a patient experience that actually builds trust instead of breaking it.

Through hands-on coaching and real implementation, we help practices move from reactive to structured so they can grow with confidence.

References

American Medical Association. (2020). Health insurer claims denial and appeal processes. AMA.

Berry, L. L., Carbone, L. P., & Haeckel, S. H. (2004). Managing the total customer experience. MIT Sloan Management Review, 45(3), 85–89.

Kessels, R. P. C. (2003). Patients’ memory for medical information. Journal of the Royal Society of Medicine, 96(5), 219–222. https://doi.org/10.1258/jrsm.96.5.219

Mani, A., Mullainathan, S., Shafir, E., & Zhao, J. (2013). Poverty impedes cognitive function. Science, 341(6149), 976–980. https://doi.org/10.1126/science.1238041

Disclaimer:

To learn more about Sarah Beth Herman, the author of all free training content you can read her bio here. These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based on your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, or insurance carrier). To the extent, Dentistry Support ®has included links to any third-party website (s), Dentistry Support ® intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support ® makes no representations or warranties about the information provided on those sites. You can view our privacy policy and terms and conditions by clicking those pages in the footer of our website