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Presenting Treatment Costs to Dental Patients Before They Ask
In a federal health survey, about one in six U.S. adults said cost had kept them from needed dental care in the past year, and patients say they want to talk about it before treatment starts, so the practice that shows the number first, in writing and with options, gives more patients a plan they can actually schedule.
At a glance
- Cost-first presentation means the patient sees the price, the insurance estimate and the payment options for a treatment plan during the same visit the plan is proposed, before they have to ask.
- In the National Health Interview Survey, 19.2% of women and 15.6% of men said they had not gotten needed dental care in the past year because of cost.
- In an older but foundational study in JAMA, 63% of patients said they wanted to discuss out-of-pocket costs before a test or treatment, while only 15% had ever done so with their doctor.
- Uninsured and self-pay patients at private dental offices are entitled to a written good faith estimate under the No Surprises Act, so a clear cost sheet is also part of meeting the rules.
Part 1 | The question patients are too polite to ask
A treatment plan usually arrives at the end of the exam, when the dentist has explained the crown, the two fillings and the deep cleaning, the patient is still in the chair with a bib on, and the hygienist is already turning over the room. The patient nods, takes the printout and thinks I have no idea what this will cost, and I don't want to look cheap by asking. A week later the plan sits in the practice software as "unscheduled," and nobody knows whether the reason was price, fear or a busy calendar.
The national data points to price. In the 2019 National Health Interview Survey, run by the National Center for Health Statistics, roughly one in five women and one in six men said they had skipped needed dental care in the past year because of cost.
Patients also say they want the conversation. In a JAMA study of 484 patients and 133 physicians, 63% of patients said they would prefer to discuss costs before receiving a test or treatment, and only 15% had ever discussed costs with their doctor; the study took place in medical rather than dental offices and is more than 20 years old, but the gap it describes is easy to recognize at any front desk.
Part 2 | Show the number in the operatory, not at checkout
The best moment to present cost is right after the clinical explanation, before the patient stands up. The steps below fit inside the last few minutes of the exam or a short consult in a quiet room.
- Explain the why in plain words. "This tooth has a crack under the old filling; a crown protects it from breaking further."
- Sort the plan by urgency. Group treatment into "needs attention now," "within six months" and "watch," so the patient sees what can wait.
- Show the full fee, the insurance estimate and the patient's share, on one printed or emailed page, line by line.
- Offer ways to pay, such as phasing the work across benefit years, a payment plan or third-party financing, with the monthly amount written out.
- Schedule the first step before they leave, or set a specific day to follow up if they want to think it over.
Part 3 | The words to use, chairside and at the desk
| Moment | What to say |
|---|---|
| After the diagnosis | "Before you leave today, I'd like to show you what this costs and what your insurance is likely to cover, so you can decide with all the facts." |
| Presenting the sheet | "Your total for the crown is [price]. Your plan estimates it will pay [amount], so your share is about [amount]. That's an estimate; we'll confirm with your insurer before we start." |
| Phasing | "The crown is the priority. The two fillings can wait until [month], when your benefits reset, which would bring this year's share down to [amount]." |
| Payment options | "If it helps to spread it out, [amount] a month over [number] months is an option; here's how that works." |
| Patient hesitates | "That's completely reasonable. Would it help if I booked a tentative time for the crown and called you [day] to see where you've landed?" |
| Uninsured or self-pay | "Here is your written good faith estimate for the treatment we discussed. If anything changes, we'll update it before we start." |
The good faith estimate deserves its own line in the front desk's checklist. Under the No Surprises Act, the federal transparency rules apply to uninsured and self-pay patients at private dental offices, who are entitled to a written estimate when they schedule care at least three business days ahead or ask for one, and the estimate must state that actual charges may differ; patients can start a dispute if the bill comes in at least $400 above the estimate.
General information, not legal or financial advice; talk to a licensed professional about how the No Surprises Act and your state's rules apply to your practice.
| Treatment plans presented per month (Assumption) | 20 |
|---|---|
| Average plan value (Assumption) | $1,500 |
| Plans scheduled today (Assumption) | 50% |
| Monthly scheduled treatment today (Calculated (20 × 50% × $1,500)) | $15,000 |
| Plans scheduled with cost-first presentation (Assumption) | 60% |
| Monthly scheduled treatment after (Calculated (20 × 60% × $1,500)) | $18,000 |
| Added scheduled treatment per year (Calculated (($18,000 − $15,000) × 12)) | $36,000 |
Illustrative example; the ten-point improvement is an assumption, not a research finding. Replace every assumption with your own numbers.
How you compare
- Unscheduled treatment: most practice software can list treatment that was diagnosed but not scheduled; total the dollars for the last six months as your starting point.
- Acceptance rate: divide plans scheduled by plans presented for one month, separately for plans under and over [amount].
- Your own baseline: after a month of cost-first presentation, compare the same two numbers.
Questions to ask this week
Who presents cost, and when? Name the person and the moment, ideally before the patient leaves the chair.
Does every plan go home in writing? One page with the fee, insurance estimate, patient share and payment options.
Do uninsured and self-pay patients get a good faith estimate every time? Check the last ten.
Who follows up on unscheduled plans, and on what day? Put a date on each one.
Pull last month's unscheduled treatment list, total it, and present cost first on every new plan for the next four weeks before comparing the result.
About this research: This article draws on the 2019 National Health Interview Survey as reported in MMWR, a JAMA study of patient and physician cost conversations (2003; foundational and conducted in medical offices), and the Centers for Medicare & Medicaid Services and ADA News explanations of the No Surprises Act's good faith estimate. The scripts and the worked example are illustrative.
Sources
- National Center for Health Statistics. QuickStats: Percentage of Adults Who Did Not Get Needed Dental Care Because of Cost in the Past 12 Months. MMWR 70(25), June 2021. National Health Interview Survey, 2019.
- Alexander, G. C., Casalino, L. P. and Meltzer, D. O. Patient-physician communication about out-of-pocket costs. JAMA, 2003, as reported by UChicago Medicine. 484 patients, 133 physicians.
- Centers for Medicare & Medicaid Services. Understanding costs in advance. No Surprises Act consumer guidance.
- ADA News. ADA addresses No Surprises Act questions. American Dental Association, March 2022.
Related reading: Explaining the Work: How to Walk Customers Through Options Without Pressure · How to Talk About Price Without Apologizing · Recall Systems for Dental and Medical Practices · Mapping the Patient Journey at a Dental or Medical Practice · Writing to Customers: Plain Language for Policies, Texts and Emails
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