The Most Common Challenges: The Estimating Challenge

I answer questions daily from dentists and team members needing help on anything from insurance to practice management. Most tend to have similar queries, so in this series, I plan to address the most common questions that plague dental offices.

Solving the “Estimate” Challenge

Most offices routinely use the term “estimate” when presenting treatment plans. However, the way we, as dental professionals, understand the term is often very different from how patients perceive it. So when they receive a surprise bill later, it can feel like a betrayal. Patients typically work within a fixed monthly budget, and an unexpected bill can throw that off entirely.

Here are some common reactions from patients who receive surprise bills:

• “I already paid my portion”
• “Take that up with insurance”
• “That is not what you told me up front”

Or the most painful one:

• “If I had known how much this really would have cost, I never would have done it in the first place”

When this happens, patients stop hearing the word “estimate” and start thinking “bait and switch.” This stems from the same reason dental “insurance” even exists: people do not save for dental care and related needs. Surprise bills can cause significant problems for patients. However, these surprise bills cause just as many issues for offices.

Consider the impact:

• Patients may refuse to pay, costing you both money and the patient relationship.
• Negative online reviews, more than half of which are about money. 
• Damage to your office’s reputation.
• A negative atmosphere your team has to deal with daily.

So how do we solve the “estimate” challenge?

Stop using “estimate” as a catch-all term that gives you cover. It’s not working. Instead, aim to present treatment plans that overestimate the cost, making it more likely that the result will be a patient credit rather than a surprise bill. No one gets upset when they owe less than expected.

Some common ways to do this when treatment planning:

Assume worst-case coding scenario:

• All crowns planned with build-ups.  
• All extractions are surgical until proven otherwise. 
• If there’s even a 1% chance a filling could extend to another surface, plan for the larger one.
• If you think a tooth might need a root canal, add it later in the plan.  
• Make yourself the hero: It’s easy to remove or downgrade treatment later—and doing so often makes you look good.
• Assume minimal insurance coverage. If you're unsure whether a policy downgrades fillings, crowns, or implants, assume that it does. If a treatment might be considered cosmetic or non-covered, assume it will be.

Overall, take every patient’s balance as a red flag to change how you prepare a treatment plan. Every single balance should have you writing down why it happened, and (more importantly) how to avoid it with every treatment plan in the future. Most balances fall into predictable patterns. If you review and learn from each one, it won’t take long to shift from balances to credits.

Of course, better treatment planning starts with better insurance verification and benefit breakdowns. If your information isn’t accurate, even the best planning will fall short. That’s a bigger challenge, and the topic of the next article.

Final Thought

If you stop relying on the word “estimate” and instead plan in a way that leads to credits, you’ll see:

• Happier patients
• Stronger collections
• A more positive, less stressful work environment

Every surprise bill is a chance to learn. Use it to improve how you work—because no matter what you do, you’re not going to change how insurance works.