How to Deal with Patients Who Tell You They Don’t Have the Money BEFORE the ROF

By Dr. Russ Rosen | Communications

In the past week, I have had a similar conversation with 3 of my chiropractic coaching clients so I thought I would write about it.

Part of our responsibility as practitioners is to be able to communicate clearly with our patients.

Today’s digital world can be dangerous for personal health because there is so much misinformation everywhere.

As a result of this misinformation, many patients come to us with expectations for the treatment’s length and cost. We talk a lot about chiropractor communication strategies and how to utilize them so that patients truly “get” what we do and want what we offer.

Chiropractor Communication Program

But what happens when a new patient brings up money even before your consult or ROF?

My ROF process specifically addresses cost by building value, understanding the true motivators behind the visit, and helping my patients understand that I am NOT viably substituted with a bottle of Advil. If you can’t get to that part of the process, what do you do?

This can be a bit tricky. I have just seen so many chiropractors ruin their relationship with the patient by using statements like, “Listen you want to get better or you don’t.” or, “You can’t afford NOT to get this care!” My favorite very well may be “Okay, tell me what you want and we will do that”. From our perspective as the certified experts, NONE of these lead to long term relationships and NONE of them honor the patient and their health!

When the cost of chiropractic care comes up at the front desk or during a pre-consultation with your CA, I would recommend that you address it right off the bat during your consultation.

Build rapport by relieving concerns and addressing fears. This would sound like:

Mary I understand that finances are a concern for you, please tell me what’s up.

Listen to what they have to say, commiserate, and say something like this:

Can I make a suggestion?
Why don’t we do a detailed consultation and thorough examination so we know exactly what is going on with you.
In my report of findings, I will tell you EXACTLY what’s going on and if we can help.
Then, you and I will get very clear about the level of health that you want to obtain.
I will show you what it will take to get there.
At that point, we will get clear about what it would cost to get to that level of health.
If we agree, then we will work together to make sure that you can get the care you need and respect your budget.
How does that sound?

A Critical Moment in the Report of Findings

During the report of findings – right at the beginning – you are going to let them know that you understand the finances are a real concern and that you simply want to help them understand the truth about what’s going on as well as the consequences of the choices that they have. This gives you the time to help them “get” what you are trying to do for them. Once this clicks, you can show them what it would take to get to the level of health that they choose. By taking it in stages, you can always customize a plan that will fit their budget.

This allows you to go through your entire report of findings without them worrying about money or that you’re going to try to hold them captive to make them do some type of care that they don’t believe they can afford. You will be amazed at how many people will find the money to get the care that they truly need once you take them through the entire process. (There’s a lot of time dedicated to this pivotal point in our Optimal Health Communications Program.)

An Example of Implementing This Chiropractic Coaching Concept

I teach my chiropractor coaching clients to record their patient interactions whenever possible. In one such recording, the patient let the doctor know right at the beginning of the ROF that finances were a real concern. She was a single parent with three children and she just truly could not afford the care.

He started talking with her about how important the care is for her now as well as for her future self.

You could hear her getting more and more frustrated… almost to the point of crying.

They were going nowhere! What came next was something that we have all experienced. The patient became extremely aggravated at her situation (NOT the doctor, by the way). She said that there are people in the world who “have” and there are people who ” have not” and she is one of the latter. She would have to get another job to afford the care she needed, but that would only make matters worse.

I want you to recognize that the doctor had not yet started the report of findings.

He had not yet gone into any details about how much care she would need or how much it would cost.

So why did she become so upset?

In this situation, her fears and misconceptions are telling her what to expect to hear from the doctor sitting in front of her. She has convinced herself that there is no ACTUAL scenario where she can get healthy and stay healthy. When this happens, we MUST de-escalate the situation before we start any type of conversation.

How do you de-escalate a patient who isn’t ready to listen?

We de-escalate the situation with the L.A.A.S.R. framework: Listen, Acknowledge, Ask, Solution, Resolution. By first listening, we are able to do something truly amazing. (LISTEN)

“Mary, I know how frustrating this must be for you.
I know that you are in a lot of pain and I know you really do want to get better.
I know you’re single mother with three children who eat like horses and the thought of having to get another job to pay for the care that you need is simply overwhelming.  (ACKNOWLEDGE)
I’m so sorry you’re going through this; I need you to know that you are not the only one.
Can I make suggestion? (ASK)
Why don’t I just go over my findings with you and show you what it would take to get this problem taken care of.(SOLUTION)
If that ends up being more than you can afford right now, we can customize a care plan that will fit within your budget.
I promise you if the amount you can afford is not going to be valuable to you – if it simply going to be a waste of your money – I will let you know. (RESOLUTION)
Mary, how does that sound?”

As always, we will use the L.A.A.S.R. process. You’ll notice the first thing I did was L for listen. I then A- acknowledged or commiserated what she was going through. I then A- asked her a question to see if that would find a S- solution and then I just checked in to see if we R-resolved this problem.

Without the L.A.A.S.R. framework, you are left with pretty terrible options:

•Roll over, agree with the patient, then just give them what they can afford right now and send them on their way

•Blast the patient with scare tactics and shame them into submission (I will NEVER agree with this option, by the way)

Neither one of those have any value for you OR your patient. Use L.A.A.S.R. and you will find you get much better results.

We go into great detail about the L.A.A.S.R. process as a key part of our Optimal Health Chiropractor Communications Program. Take a look – if this article has been helpful, it may be what YOU really need to move forward and help your patients “get” what you do.

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