Borat, $72 and Our Practices

I was watching Borat’s Subsequent Moviefilm (please don’t judge me) and while his movies cause me to cringe while barely being able to watching the screen, there was one scene that got my full attention. (There’s no spoiler alert here so don’t worry if you haven’t seen the movie.)

There’s a scene involving a plastic surgeon and a procedure. It’s a silly, useless scene, but like many of the situations Borat gets himself into, there’s something insidious uncovered in the the response of his “interviewees”. In this case, the surgical fee, presented by the treatment coordinator, is approximately $21,000+. Borat hands over $21,000 and after counting the cash, the treatment coordinator says:”You’re $72 short and we can’t do the procedure until we get paid in full.”

Was this legitimately what happened or was it scripted? Who cares. The point is this: How often do we make accommodations in our offices for less than we deserve? Not because we chose to, and not because of charitable reasons, but rather because of a Borat-like situation. Maybe it’s being on insurance or giving a discount for siblings or phase I, but you’d be hard pressed to find any orthodontist who got paid an up front full fee for every case started in an entire year (not including charitable write offs).

I think that most of us would agree that a $72 cash/bookeepers discount is fair on a $21,000 procedure, and it’s my sincerest hope that the need for thee $72 to do the surgery is all part of the script of the movie, but how many times has your treatment coordinator been faced with a patient who couldn’t afford the down payment, or wanted to make payment plans outside of your comfort zone? What was the attitude of your treatment coordinator? Did it align with your mission and culture of your office.

I’m not saying there’s a right or wrong here, because our decisions should match our own moral compass, but you can’t go into a supermarket and pay less than advertised, and you can’t pay the plumber $205 instead of $225. So, whey do many of us orthodontists happily reduce fees, accept less than we should or make crazy payment arrangements to start cases? Again, I’m not saying it’s wrong, but I think int warrants some thoughtful consideration and a written plan in our offices.

The other thing that stood out to me is that surgeons (and many dentists) regularly charge their full fee up front and won’t do the elective procedure until it’s paid in full, while orthodontists gladly take payment plans over the course of years. How did that happen? Food for thought.

I think it’s funny that after watching all of the insanity from this 2nd Borat installment (and there is A LOT of insanity) the part that stuck with me is the $72 scene. Maybe because I didn’t like a plastic surgeon holding out a surgery for a mere 0.3% of the fee. Or, maybe that was amazing script writing meant to make me think over the scene exactly as I am.

Either way, I’d love your thoughts. Should we simply accommodate our patient’s financial needs and work with them in any way we can, or, like the plastic surgeon in the movie should we stand firm in our financial policy and lose a case for less than 1% if that’s the way it needs to be?

Wishing you the best,