📍   Hey everyone. Welcome back to the No Silver Spoons Podcast. Before we get into today's episode, I want to tell you exactly what this conversation is about. This is a story about trust, miscommunication, money, leadership, and a moment inside of a dental office.

That should have never happened. It's about what it looks like when a patient experience starts out beautifully, and then it unravels in a matter of minutes. And more than that, it's about the lessons that come from moments like these. Because in business, in leadership, and especially in dentistry, the moments that go wrong often teach us more than the moments that go right.

So today I'm gonna walk you through a very personal experience I had with a dental office I trusted. Why it affected me so deeply what went wrong and what every office should learn from it. For those of you who may be new here, my name is Sarah Beth. I'm the CEO of Dentistry support.

I am someone who genuinely loves business strategy, leadership, education, and the work it takes to make an organization stronger. That's really the heart behind this podcast. I created no silver spoons because I don't believe people grow the most from polished theories or surface level conversations. I think people grow when they hear real stories, real situations, real mistakes, real turning points and real lessons that can actually apply.

My goal with every episode is to bring you something meaningful, something you can take back to your leadership, your practice team, your life, and use it in a real way. I also wanna remind you that this is not just a podcast you listen to and you move on from. We support every episode with free training across our platforms, and every Thursday we send out emails to let you know what the upcoming episode is about so you can listen with intention if you have not already done so, make sure you subscribe, download, and listen to all of the episodes we have.

Share them with your team. Stay connected with us. The more engaged you are, the more value you are going to get from everything we're building around this show. Now let's get into today's story. This episode is not about calling out an office by name.

I'm not gonna do that. It's also not about tearing down a colleague. In fact, that's part of what made this so difficult. This was a dental office connected to someone I have known and trusted in the dental community for more than 15 years. Someone I respect, someone I believe in, someone I felt confident referring my own family to.

And in our world, that means something. And you refer people you love to a practice, you're placing your own reputation on the line. You are saying, I trust this office enough that I'm willing to send the people closest to me there. That's not a light recommendation. That's why this story hit me the way that it did.

My family had a specific state aid plan with benefits of up to $4,000 that could be used for services. At the same time, they struggle financially in a very real way. My stepmom in particular, makes about $1,200 a month. She has also dealt with serious and debilitating health issues over the years, including organ transplants and other life-threatening situations.

So when I say there is not much margin in their monthly life, I mean that literally because I knew that I made a very intentional decision before they ever became patients there. I called the office myself when I scheduled the appointment for them and I spoke with the front office team.  I told them very clearly that if there was any expense at all, I wanted them to contact me.

I told them they could keep my credit card on file, and I would gladly take care of any balance. I also explained why I was handling it this way. I did not want my family to decline treatment because of money, and I knew that if they believed they would owe something that they could not afford, they would simply say no, even if it was treatment they needed.

So I was going to remove that stress for them. The office assured me that they would get pre-authorizations. Make sure things were covered and contact me about anything that was not covered. I trusted that answer and because I trusted it, I didn't tell my family that I had offered to cover anything additional.

I kept that to myself because I knew they would not want me paying for their care, and I didn't want pride or finances to get in the way of them getting great dental care. They went to the office. And in the beginning, the experience was truly incredible.

From the way they were greeted to the way appointments were scheduled, the chairside manner to how treatment was explained, everything was wonderful. They came in for a consultation just like any normal office would do. The office submitted for pre-authorization. Their treatment was scheduled in phases.

The approved items were communicated to them. And they started treatment, and by all accounts, it was going really, really well. I was hearing nothing but positive things at every appointment. My family was happy. They felt cared for, they felt respected. They were impressed by the office.

I was also in communication with my dental colleague during this time, and when they checked in to ask how everything was going, I told them it was going amazing. And honestly, it was as good as I could have hoped for. My stepmom had a crown and a filling appointment that went great Later, she needed to go back in for a crown adjustment, which is completely normal.

That happens all the time, and there was nothing unusual about that part of the story. What mattered is what happened at the adjustment appointment. While she was there,

they asked her whether she wanted to go ahead and complete treatment on the other side, the same day on the surface. That sounded convenient, efficient, helpful, even, and she agreed. She signed the forms and the treatment was completed. But what she believed she was signing was the consent to move forward with care.

What she did not understand was that there was a balance associated with that treatment. And that by the end of the appointment they were going to expect payment that same morning while they were on their way to the office. I had actually spoken to them. We were talking about an upcoming trip and they mentioned they were heading to the dental office.

I told them like I always did that if they needed anything at all to let me know, and they reassured me that there was nothing that they needed. They said everything was great, insurance was covering everything. The office had explained it all really well, and they were in great hands. Then I went into a meeting where I was tied up for a few hours and I was unavailable to answer my phone.

When I came out, my phone was literally blowing up. I had missed calls, text messages, more calls, more text messages.  I remember that sinking feeling that hits before you even know the details. You just know something's wrong. And when I finally was able to open the messages and read them, my stepmom had texted me that they wanted $1,460 and they wouldn't let them leave the office until they paid it.

And I froze momentarily. My family did not have that kind of money. There was no scenario where they had anything near that kind of money. So I called immediately and I asked my dad to put me on speaker. The moment I got on the call, it was chaos. Everyone was talking at once. My stepmom was upset, crying, trying to explain that she had no idea she would owe anything she was saying.

She would never have agreed to treatment. If she had known she would've had to pay something or even anything near that amount. They don't even have that much money, and I believe that completely because I know their finances. She does not bring in enough money to casually agree to a $1,460 bill. It just didn't make sense.

At the same time, a team member kept saying on the phone and a very defensive tone. Mind you, I have it highlighted and circled right here. I have your signature, so I'm going off of what your signature says. The reason that part hit me so hard is because that's not the tone of someone trying to solve a problem.

That is the tone of someone trying to defend themselves in the middle of one. So I asked a simple question, walk me through when you found out this wasn't going to be covered, and they told me they had known since February, which would've been a few months ago. That part stopped me in my tracks because if they had already known since February that this part of the treatment was denied, then why was treatment completed that day without a direct financial conversation?

Why was I not called? I have a HIPAA release. There were notes on the account that I was the person that would be financially responsible. Why was my stepmom who was there for an adjustment being asked in the moment if she wanted to go ahead and do the other side without a crystal clear explanation that this was not covered and would require payment?

Now I'm gonna pause for a second because anyone in dental is probably saying, oh, they just wanted to convert same day treatment. So they were trying to do that. Yeah, I get it. But both me and my stepmom had let them know in our own individual conversations that she was not going to move forward with treatment if there was a cost associated and I had let them know specifically to call me if there was money due and not discuss it with her because I wanted her to receive the treatment.

If they would have told her that there was an amount due, she would not have moved forward, which I would've still called them and had a conversation saying, why didn't you call me? I have all of the releases on file for you to discuss financial with me, so I'm not really sure why that didn't happen.

Okay, let's keep moving on here for a second. I then asked the team member on the phone whether there was a way to appeal the decision, and what I now know is that she was always talking about a pre-authorization. The pre-authorization was denied. I said, can you send a better narrative? Can you figure out if there was an alternative benefit or another way to get this approved?

And the response I got was essentially that  this insurance, would never approve an appeal on a pre-authorization, that it was nearly impossible, and that there was really no way to do that. And that answer bothered me deeply, not just because I disagreed with it.

 But because it reflects a mindset that I see too often in dentistry, something is hard, once, so people decide it's always hard. Something has been denied before, so people stop trying. Something takes effort, so the answer becomes no. But hard is not the same thing as impossible.

If a procedure is not medically necessary and truly cannot be approved. Then the clinical conversation needs to reflect that maybe a lesser service should be offered. Maybe there's an alternate benefit. Maybe a stronger narrative is needed. Maybe the documentation needs to improve.

 Maybe the answer is still no, but you do the work to find that out the right way. What you do not do is tell the patient there is no path forward when you haven't even fully tried. And you definitely do not ignore account notes that say very clearly that a family member is handling the financial responsibility and needs to be contacted.

At that point, I asked them to bring in the treatment coordinator who presented the treatment plan because I wanted to understand exactly how it had been communicated. They told me she was on the phone and I said, that was fine. We could wait. My goal was not to argue about who owed money in that moment.

My goal was to understand what happened. And when she finally came in, things got even worse. What followed was one of the most chaotic and inappropriate professional interactions I've ever experienced in dentistry and ever in my professional life. Everyone was yelling. People were interrupting each other.

There was finger pointing, there was blaming. One person said they circled it, another saying it was signed, another. Defending their process, everyone trying to prove that they had done their part while no one was taking a step back to actually solve this situation in a calm and respectful way. And all of this was happening while my family was standing there in distress.

I could hear my stepmom hysterically crying. My dad was trying to calm her down. My heart was pounding. I had so much anxiety. I was embarrassed. I was mortified. I could hear everyone getting more and more upset, more overwhelmed, more afraid, hysterically crying. My family terrified in this office. So finally I just said, absolutely not.

We are not doing this. I told them I was going to take care of the balance, but I also gave them some advice that I believe every dental office needs to hear. First, if a family member has already said they're responsible for the balance, then why are you putting that burden on the patient in the operatory or at checkout?

Why was I not called Second? If there is going to be a balance for treatment that day, then you collect it up front. You do not wait until the end and spring it on. Someone who believed everything was covered, signature or not, a bird in the hand is worth two in the bush. Collect the money when expectations are clear, not when emotions are high, and treatment is already complete.

Had that happened before, this entire situation could have been avoided. Now I know exactly what everyone in dental is thinking right now. , The reason they probably didn't collect when the patient was in the chair is because of treatment changes and the dollar amounts changed.

They gotta run payment again. I don't care. Run payment again.  You need to collect money immediately. You should not be waiting. Do you know how many scenarios I have seen and heard? Where this very situation has happened where someone says, okay, I'll do it, and then says, oh, I didn't know I was gonna pay it.

I can't pay it. I'm leaving. And they leave the dental office and they literally never pay the bill. Do you know how many times I've heard that scenario happening?

Back to the story,  in the middle of all of this, after telling me how impossible an appeal would be. The office manager suddenly said, , I don't need your money today, Sarah Beth, I'm gonna go ahead and send in an appeal that made the situation even worse. And I think you probably already know why.

Because I had already asked if they could appeal it, and I had been told all the reasons they could not. So to then pivot and say, actually nevermind, we can appeal it. Only reinforce for me that this was not being handled from a place of clarity or leadership. It felt reactive. It felt inconsistent, and it made me think, if you truly did not need my money today, then why were my family members being told they could not leave until they paid?

That contradiction mattered. In the end. I did pay the $1,460, but the money was never the point. The point was the way it was handled. The point was the shouting, the finger pointing, the lack of accountability, the complete collapse of communication. And the emotional damage done to two elderly people who were already vulnerable.

My family left that office crying and shaken, not because dentistry is scary, not because treatment was painful, but because the business side of the experience became so mishandled that it created fear, humiliation, and panic. And what stays with me is this. The office itself was beautiful. The experience leading up to this was so good.

The care had been excellent. That is what makes this such an important lesson.  One moment can undo so much good one. Breakdown can erase a long list of things done right. That is not just true in dentistry, though. That is true in business everywhere. The way a team handles pressure tells you everything about its leadership, its systems, and its culture.

When things are easy, almost any office can look polished. But when something goes sideways, that is when you see whether people know how to communicate, whether they know how to pause, whether they know how to regulate themselves, and whether they know how to protect the patient experience. , The right response would've sounded something like this.

Sarah Beth, let's pause for a moment. This is escalating. We're going to review what happened, submit the appeal, look at the notes on the account and figure out how this was communicated. If there's still a balance after that, we will have a calm conversation with you directly. Does that sound fair?

Perfect. That would've been leadership. That would've been accountability. That would've protected everyone involved. Instead, what happened was complete chaos. And I wanna say something else that I think is really important here. Too many front office teams have become very skilled at explaining why something can't be done, why the insurance won't approve it, why the appeal won't work, why the patient owes it, why their process is correct versus your question why there's nothing else they can do.

What they have not become equally skilled at is solving the problem, and those are not the same thing. A team that can explain away difficulty is not the same as a team that can lead through it. This is one of the biggest gaps I see in practices. People get attached to the first obstacle and they start treating it like the final answer.

 But business doesn't work that way. Leadership doesn't work that way. Entrepreneurship certainly doesn't work that way.

People who build, lead, grow and succeed hear no all the time. They hear no before they hear. Yes. They hit walls before they find doors. They revise, they resubmit, they rethink. They ask better questions. They improve the narrative, and then they keep going. That is what leadership looks like. It does not mean every appeal will be approved.

It does not mean every patient will get the answer they want. It does mean the office has a responsibility to approach the situation with effort, composure, clarity, and care. That part is not optional. So at this point in the episode, this is a good moment to pause and pull out the lessons.

If you've been listening here at No Silver Spoons for any length of time, you know I have a, that's good moment in every episode.

My, that's good moment is just basically, Hey, what's the summary of everything we've learned or what do I want you to take away from this episode? That you can then put into practice in your own life and in your own business. Number one, if someone else is financially responsible, your notes need to be clear and your team needs to honor them.

Do not default to the patient if the arrangement is already documented, if there's already proof, if there's already consent signed, if there's already permission granted. Number two, a signature is not the same thing as understanding. Just because something is highlighted, circled, or signed does not mean it was truly explained in a way the patient understood.

Number three, if there is a balance, collect upfront. Do not complete treatment first and create confrontation later. Number four, hard does not mean impossible. A denied pre-authorization is not automatically the end of the road. Ask more questions. Explore the appeal. Improve the narrative. Look for alternate benefits

 number five, when a situation escalates, leadership matters more than process. Stop the chaos, slow the conversation down. Protect the patient. Pause the moment it. Number six, one bad moment, can erase 10 good ones. You can have a beautiful office. Kind, chairside manner, an excellent treatment plan. But if the financial communication collapses, that is what many patients will remember.

And finally, number seven, accountability is not about proving who was technically right. It is about taking responsibility for finding the best next step, and that is what this episode is about. Yes, I talked about a $1,460 bill, but more than that. It is about the cost of poor communication. It is about the damage done when people become more committed to defending themselves than serving the patient in front of them.

And it is about the fact that in every business, not just dentistry, the moments that define you are usually the ones you didn't plan for. So as you listen to this episode, I want you to think about your own business, your own team, your own systems. Where are things being assumed instead of clearly communicated?

Where are people relying on signatures instead of conversations? Where are notes being entered but not followed? Where are team members explaining why something can't be done? Instead of trying to find out whether it can be done? Where are patients being handed? Stress that should have been handled internally before it ever reached them.

Because those are the places where the trust gets broken, and trust is everything. Thank you for being here with me today. Thank you for listening to the story, and more importantly, thank you for being willing to learn from it. If this episode resonated with you, make sure you subscribe, download the episode and share it with someone on your team who needs to hear it.

Stay connected with us for Thursday, emails and free training releases. So you know what's coming next and can keep growing with us beyond the podcast. And as always,  📍 I'll catch you on the next episode.