Fontainebleau Miami Beach, FL
December 1st & 2nd
The Closing Institute’s Full-Arch Growth Conference
Leslie Ramos: How are you?
Bart Knellinger: I’m good. I’m good. How are y’all doing?
Bart: Cool. I’m not in the office today. We’re up in South Dakota. South Dakota. We got a Mastermind group up here with some clients for the people we do business with.
Leslie: You’re not far from us, then.
Bart: Oh, yeah. Where are you?
Bart: Oh, yeah, that’s right, driving distance. That’s right. I’m just giving everybody a minute to sign in here, guys. We still got a bunch of people signing on right now. What’s up, Erika? Okay. So, look, guys, we got a video to review today. Oh, just to let you guys know if you’re wondering why I’m in a hat and kind of weird room, I’m not in the office right now. We’ve got a Mastermind group the last couple of days up in South Dakota, where a group of us come up, and we meet about business, we do some [inaudible] and then we go back. So, that’s where we are right now. That’s kind of why I’m sitting here all casual out for you today but I didn’t want to miss the call. So, we’ve got a really good call. It’s actually from Dr. Davis’s office, and Jolie was the one doing the call. She did a really good job but I think there are some important things that we can learn from it. So, I’m going to go ahead and if y’all are ready, I’ll get started in a minute.
One of the main things to keep in mind here is that it’s really important that the patient leaves with some kind of primary recommendation from the second ten. I’ll show you, but it’s really tough as a treatment coordinator to overcome it. If the doctor had made a primary recommendation, if they just give you like three or four possibilities, they’re kind of leaving it up for the treatment coordinator to decide or the patient to decide what is the best route. Ideally, you want the doctor to make that decision, which is the best treatment plan to give what it is that we’re trying to accomplish. But I’ll give you an idea of what I’m talking about with the video, but Jolie led it pretty good in a couple of different areas. I think it’s something that we can all learn from. So, hang on, I’ll get the video started. Here we go. Turn your volume up.
Jolee: I’m Jolie, I’m one of the treatment coordinators here at the office. What I’m going to do is talk to you a little bit more as far as what brings you in, some of your concerns, and what your future goals are for your teeth. So that way we can get some possible options and see how we can help you before the doctor comes in. Okay? I know you took some time to fill out our little implant form so I thank you for that. Tell me a little bit more about your teeth.
Mr. Jones: About three years ago, just before the pandemic, I lost…
Bart: Do you guys remember what the whole point of the intro is? The whole point of the intro when you’re stating your intention is for them to make the connection that you’re only there to find out where they are now, where they want to be, and the treatment plan is going to be an accurate reflection of where they tell you they want to be. That’s really the whole point of stating your intention. So, Jolie went through it, she kind of did it, but it just needs to be smoothed out a little bit. You want that part to be really, really clear, right? Their job as the patient is to tell you where they are, and where they want to be, and between you and the doctor, your job is to create a treatment plan that’s going to get them from where they are to where they want to be in the most efficient manner. Those are the roles of all the parties involved here. That’s the whole point of stating your intention. So, make sure that everybody has that down. You want to smooth that out.
Mr. Jones: Now, this tooth got a little something.
Mr. Jones: The one here. On this side of my teeth, I had another with a bridge, a porcelain bridge. Oh, those three together became loose. After I had this one. These ones were loose and they just kept being loose, kept being loose.
Jolee: Getting looser and looser.
Mr. Jones: And I ignored them until I was eating pizza or I was eating something, and all of a sudden, they fell down in my mouth. They just fell down. Okay?
Mr. Jones: I didn’t bring them with me. I apologize.
Jolee: Yeah, you’re fine.
Mr. Jones: And that lasted from when I was 15.
Jolee: The bridge?
Mr. Jones: Yeah.
Jolee: So, you got a lot of time with it.
Mr. Jones: A lot of time with that one. Before that, I had a tooth that they replaced with a stainless steel cap while I was in high school or Junior High. Mr. close your mouth, you’re blinding me. Famous jaws, whatever. So that was unpleasant. So when I was about 15…
Bart: I mean, this guy can’t even eat pizza without a tooth coming out of him. Pizza, you know. It’s not that hard to eat pizza but you see when you’re dealing with somebody, this guy, right now we’re four minutes and 56 seconds in, right? The problem is a lot of this stuff for him is normal and normality prevents urgency and creates complacency, right? So, he needs to know that that’s not really normal. I mean, guys got a bridge from 1942 so he’s just been dealing with these issues, putting Band-Aids on them for a long period of time. Sometimes when you have somebody that’s been doing that, you really have to nail the quality of life, raw aspect to get them to create enough urgency for them to move forward because they can just put up with being uncomfortable. This guy is an expert at coping with being uncomfortable as far as teeth are concerned. He’s had problems with the teeth his whole life. He can’t even eat pizza now, and he said it like it wasn’t that big of a deal. Did y’all pick up on that? He wasn’t even traumatized by that. I don’t know what I would do if I eat a piece of pizza and a tooth came out. I mean, I would be running somewhere, right? That’s bad.
So, this guy, to him, all of that stuff is just totally normal. Okay? So, you realize if he maintains this level of complacency, he’s probably going to be 100% price-focused at the end. Do you know what I mean? We want to transcend price with him but for this guy, right now, I’m already thinking, man, all this stuff is normal to him, it’s everyday life. So, to him, it’s completely normal, I’ve got to do something about that.
Mr. Jones: …I think 16. My parents went and got the bridge with the porcelain. On this side, before this fell out, I had this one removed.
Mr. Jones: It got loose. Then this fell out about two or three weeks ago. It finally fell out. That was really loose and then I called and made an appointment, an initial consultation. Part of it is getting a second opinion or a better opinion.
Jolee: Okay. Tell me a little bit about what they told you there.
Mr. Jones: The last thing that happened is I was eating pizza crust, and this tooth just broke off. Now, the other teeth were all fine. It just fell off. Right?
Mr. Jones: So, three years, that’s an alarming rate to lose six teeth. Actually, you got the four here and two on the side. I got six teeth.
Jolee: There’s definitely something going on as to why your teeth keep coming out, right? Tell me a little bit about what the other doctor said.
Mr. Jones: He just said there is some infection. We’ll see what you think about that.
Bart: What do we need to find out right now? I want to find out how losing these teeth are affecting his life, right? We want to always relate it back to that. Because I’m trying to create urgency. I can’t create urgency with the mechanics of a conversation or talk about how many teeth I’m losing or how many have lost or this, that, or the other. It’s really, like, what is losing teeth doing to diminish his quality of life? That’s where the emotion gets involved. And Jolie does a really good job right here staying quiet. Sometimes you have to allow a moment of silence when they’re gathering their thoughts but watch this. She does a pretty good job right here of letting him gather his thoughts but that’s the very next place we want to go here.
Mr. Jones: So, anyway, I played the horn, or I used to.
Jolee: Okay. Before these fell out.
Mr. Jones: Yeah. And I’m not so egotistical, but if I go back to work, I’ve been retired since COVID. I do not have dental insurance so, whatever I do, I’m probably going to have to pay it out of my savings, which looks like it might be a pretty good sum. So, here I am. One more tooth out makes it seven left. And so, I’m at that… there’s one doctor that said, a tipping point.
Jolee: That’s what I was going to say. There’s something going on, okay? And you know that.
Bart: You got teeth falling out when you’re eating a pizza, you’ve tipped. Right? We’re not at the tipping point. You’ve tipped over, fallen down, and can’t get up, right? It’s bad.
Jolee: We just got to help you figure that out as to what’s going on.
Mr. Jones: Well, as far as the infections, I’ve had infections.
Bart: What I would like to hear more right here is for her to elaborate when he said, he wants to play the horn. When he said he likes to do that. He touched on it for a second but he didn’t really go into it. I would like to hear a little bit of elaboration on what type of quality of life does he want to have and what does he have right now? Do you know what I mean? Especially, because did you hear him? He went into saying, I like to play the horn, I would like to play the horn, and then his brain just totally switched to money, right? Just immediately went to money. So, again, with just the whole pace and leading technique here. You guys, you know what kind of information you’re after. When they crack the door open, you got your foot in the door with something like the horn or something that is going to lend itself to create urgency and give you a little bit of insight into how their suffering in terms of their quality of life, then make sure that you push that door open and create a line of questioning based around that.
“Oh, so you like to play the horn? How long have you played the horn? So, have the teeth that you’ve lost, has prevented you from playing anymore? God, that’s terrible. How long has that been? Okay. And you said you can’t eat pizza now, what kind of things can you eat? Pizza is not the hardest thing in the world to eat, right? If you can’t eat pizza, what can you eat now? How long have you been dealing with that?”
Jolee: Bart, back when he was saying that the bridge had fallen out, that was why I touched based on when he said he liked to play the horn, that’s why I kind of pointed and I said before the teeth fell out.
Jolee: That was kind of my way of touching and elaborating on that but I definitely should have gotten more into it.
Bart: Yeah. You can just ask some questions about, hey, how long have you played the horn? So can you not play the horn anymore? Boom. And one thing will go to another but what he did is he mentioned the horn and he didn’t really give you a chance, you tried to interject but he went straight into talking about pricing and the other doctor and all that stuff. So, sometimes when they do that, you tried to interject but he kind of kept going, it’s okay. You just make a mental note of it and whenever they do stop, then you go back to it and ask the question, like, “So, I’m curious about the horn and you said that you liked to play the horn. So does that mean that you can’t play the horn anymore?” Do you know what I mean? And just let them keep going so that you’re not talking over them, but go back to it because you know you want to get him to explain. I want him to tell me how his quality of life has deteriorated due to the fact that he’s been losing all these teeth.
He said six teeth in three years, it’s probably deteriorated exponentially in the last three years compared to what he was used to before that. So, I just want to try to get a description from him, right? Once I get the description from him, then that’s what you use to create urgency, and that’s what transcends dollars and cents. Be miserable every day, what’s it worth to not be miserable every day, right? Loving to play the horn and not being able to play the horn, what’s that worth in terms of dollars, right? Wanting to go out to eat with somebody and not being able to go eat even a piece of pizza, what’s that worth in terms of dollars and cents? So, it’s the diminishment in quality of life that transcends dollars and cents, and that’s a really important fundamental element because if the dollars and cents are not as important as the quality of life, then we’re really going to be looking during this consultation for a solution to the quality of life problems. Whatever the solution is, whatever the best solution to his quality of life problems is, there’s a cost associated with it and now we just have to figure out how to pay for it.
It’s not, “Am I going to pay for it?” It’s not, “Do I want to pay for it?” It’s kind of a foregone conclusion because it’s not worth it. All the money in the world isn’t worth living like this. Does that make sense? So, you guys want to hammer that, anytime they give you an opening there, make sure you do it, especially with somebody like this where he talks of losing a tooth in Pizza like it’s no big deal. He talks about losing teeth, in general, like it’s no big deal. He talks about it’s no big deal to be having a bridge since he was 15 years old, this guy ain’t young. Especially when you have somebody like this, you know you need to disturb their complacency and I’ve got to plant the seed in his head that this isn’t normal and that this isn’t good and even though you think it’s normal, it’s a horrible quality of life. You could have such a better experience, just walking around every day if you have good oral health. If we fix this problem, your quality of life is going to go up exponentially. Right now, it’s normal for you but it’s not normal for anybody else. That is what I have to get across to this guy.
Mr. Jones: …problems all my life practically. There was a time before I even started all this when I was in Seattle when I had an infection in my nose and kind of went this way. It was like a little mole, and then just not too long, about five months ago, I had another infection. I knew it came out of that one tooth. It went up in there and it come across and down. So, I had infections but that kind of cleared up and I don’t know how bad it really is, okay? But other than going to a primary care doctor and trying to get some kind of antibiotics or something like that, I’ve never really bought anything. I fought COVID off. It hit me in January. I had it when it first came out in January/February there. I had it for about three weeks. I knew I had it.
Bart: So we’re still just talking about pain points here. I would like to see the conversation be more about how it’s affected his life and then a transition into what he wants. Okay? So, what is it that we’re trying to accomplish here? Obviously, we have to stop the progression of losing teeth one by one. That’s not going to be good, right? The question is how do we stop it? What do we want to do? What do we want to accomplish? What do we want in terms of function, aesthetics, and maintenance? What are you looking for? There are a lot of different ways to address it but I want to get you what you want. So tell me how you want to feel, how you want to live, and what you want in terms of function. Do you want to smile that can blah blah blah, right? That’s where I want to see the conversation go right here. I’m going to fast-forward up a little bit. I want you to see the second content and Jolie did a pretty good job of staying on track here in terms of time. Actually, it’s not going to be Dr. Das coming into the room, it’s going to be Dr. Fam.
Jolee: All right, Dr. Fam. So, Mr. Jones is coming in because, over a short period of time, he’s had some teeth in the front start to fall out, teeth on the side. He knows that there are not a lot of teeth left on top. He is here for a second consultation and a second opinion, the other doctor did tell him that he has a lot of infection up top and that they talked about doing some implants and stuff to give him his smile back but he just wants to see what we recommend. So, we want to know what his options are. We’re just focusing on the top for now and see what those options are and he is interested in implants. He does have a strong gag reflex.
Dr. Fam: So, a denture might be really hard for you.
Mr. Jones: I want to play the horn.
Dr. Fam: Okay.
Mr. Jones: I don’t think a denture will support a horn.
Dr. Fam: It might be difficult. But I do agree there is quite a bit of infection here, here, and a lot of bone loss. So, the bone is the foundation to hold your teeth. So, the foundation should be down here but up here. So, foundation-wise, this is not the strongest. What we don’t want to do is build a brand new house on a poor foundation, okay? With that said, it just looks like I agree with the other doctor. It would be best if we just remove all these teeth and then place implants.
Mr. Jones: Yeah, he was twitching between that. When I pinned him down to recommendation after talking with him, we had talked about just doing the six and putting pegs on the bicuspids, and making these tags. I was overwhelmed. At the time, I was thinking, well, if I can save them if they’re going to last, so that’s the unknown. If they’re going to just keep dropping out as they’ve been for three years, 16, you know? And then these two here, this was recently just broken off, so this one was dead, just stamped up and waiting on some, but this one is loose and it pulled out. So this was a good tooth. That was a good tooth. There was a crown in between two teeth that lasted me 50-some years. And so, when we talked about doing a peg here and a peg here and then a bridge across just like my old crown, there was a bridge… six.
Dr. Fam: Here, let me take a look, okay?
Bart: See? But, again, I’m saying, hey, okay, look, what do you want out of this? What level of function are you looking for long-term? What are you looking for? Are you looking for a level of function to return to when you have naturally healthy teeth? Is that what you’re looking for? I don’t even know what a peg is. We’re not doing a peg and a peg and a bridge. Right? Are you looking for something that’s going to be the quickest way to just get by or do you want something long-term? What are you looking for here?
That’s a question that needs to be asked. What do you want in terms of aesthetics? What are you looking for? Do you want something that comes in and comes out? Or do you want something that’s screwed down that you’re not going to worry about? There are a couple of different ways of doing this but what do we want in terms of an outcome? And then that’s how the doctor takes control and that’s how you do also. But whenever a patient starts talking about, oh, well, they said I could do this and this and maybe I think that I want this or maybe I think that I want that. That’s a good time for you guys to stop and say, listen, tell me what you want as an outcome. You tell me what you want as an outcome, I’m going to tell you how to get there. You don’t tell me how to get somewhere because it could take you to a place that you don’t want to be. So let’s agree on the place that you want to arrive at and then I will tell you what the best way to get there is. Sometimes you have to take control in that instance. Let me fast forward a little bit here.
Dr. Fam: It’s like buying a brand new Ferrari, but that was kind of like flooded. You’re trying to fix that.
Mr. Jones: It was in a flood. That’s a good analogy.
Dr. Fam: Yeah. You’re going to put a lot of money into it but it might not work out. We lost a lot of good foundations and I’m actually going to refer you to our senior doctor. So, he’ll take a look at your case a little more just because I don’t see a very good bone upfront, he will have to find bones in different areas of your jaw to place the implants. Okay.
Mr. Jones: So, I pretty much assumed that this was up for implants.
Dr. Fam: We’re going to utilize bones elsewhere so we’re probably going to use right out front. But it’s kind of like different angles and you’ll have to be creative with that.
Mr. Jones: I’m not aware of that.
Dr. Fam: So that way you have the best result versus you trying to salvage what you can.
Mr. Jones: Okay, well, what if he comes back and says, you can’t save the foundation? Am I done?
Dr. Fam: There is one other route but then we’ll cross that bridge if we have to. Basically, utilizing bones closer to the orbital bone. I’m not going to go into it because it’s a little confusing. Let’s cross that bridge when we get to that.
Mr. Jones: Well, it’s not the same as my neighbor who told me she had cow bones put in.
Dr. Fam: No. No, it’s not like that.
Mr. Jones: Seriously. I go, oh, wow. I don’t know what’s that. Now, we’re getting major surgery. I’m not a rich man and I have a limited amount of retirement savings.
Dr. Fam: I understand.
Mr. Jones: I’m really fretting over that as it is. So, I don’t know. Well, I appreciate your opinion. I do. I’m not just saying it and I’d consider it. It makes a lot of sense but…
Dr. Fam: The dentures will be the worst-case scenario, but at least we know we’re not investing a lot on trying to save what you can’t and then you’re just losing that much money.
Mr. Jones: So, you’re going to consult with him. Can you give me any idea of…?
Jolee: I’ll give you the numbers now.
Mr. Jones: I don’t like to waste people’s time.
Dr. Fam: No. What we do is we can give you a rough estimate, we’ll consult with the senior doctor, then we’ll do follows up if needed. If we can do it over the phone, we’ll do it. If he wants to see you in person, they will let you know.
Mr. Jones: Okay.
Dr. Fam: All right.
Bart: So, the problem with this is, all right, we’re going to give you rough estimates but we don’t even know if we can do this. So, I don’t know how you close it, right? Jolie is probably going, oh, crap. I don’t know how she’s going to close it.
Jolee: But I did.
Jolee: I closed it. To be fair.
Bart: You did. You did close it. You closed it after this but, at this appointment, it’s almost like it’s set up not to close. Because we’re telling the guy, “I have to consult with the other doctor,” do you know what I mean? I mean, we’re telling them, I got to consult with the other doctor. In an ideal scenario, we can decide, hey, it is this. Is this a case that we can do or not? If not, Kim, is this as I go or a pterygoid case or not, Right? But one of the two. It’s either is or it isn’t. And then we’re either making a recommendation, yeah, we can do All on 4, or, hey, we can do all in for in the bottom, we’re going to do pterygoid on top. Something, right? Because you want to instill some confidence in this guy too. This guy right now, he’s gone, man, I don’t even know if they can do it. The good news is it probably helps to serve his complacency a little bit. It creates some urgency, but he’s probably like, okay, I got a lot of bone loss, I don’t know if they can do the implants or not or there’s this other thing using bone from my orbital cavity that they might have to do, but he doesn’t know.
So, this doctor doesn’t know what to do so he’s got to talk to the other doctor to figure out what to do, and then after he talks to the other doctor, what? They’re going to call me or they’re going to text me, something like that, and tell me, and then we’re going to make a decision. We just ran into an issue here where no matter what Jolie does, she’s just going to give a couple of hypotheticals, right? Because until a doctor walks in the room and says, hey, you’re a candidate for this, this is the best way to do it, and here’s what we’re going to do, their kind of just hypotheticals. Does that make sense?
So, Jolie, what were you thinking when you saw it on the CT and you talked to Dr. Fam, are you thinking, is this going to be as I go or can we do All on 4? Was it clear to you that he was a candidate for All on 4?
Jolee: I wasn’t 100% sure because the patient had a lot of infections. So, Dr. Fam doesn’t do like some of the more complicated cases so that’s why Dr. Fam framed it the way he did, and Brenda corrected him on that. But he wanted the patient to kind of know that if we can do the surgery, this is going to be with Dr. Das because it’s more complicated. So, I want to say, I don’t remember, I think it did Terry’s in this case, but, yeah.
Bart: I mean, was it like, hey, we can definitely find enough bone on the lower to do implants? Did he know enough about that? Because sometimes like, look, I know that we’re good on the lower teeth, we’re going to be able to find it. He said you can be creative and figure out areas to put the implants and things like that but we need to do it quickly. So, that’s what we’re going to do on the bottom, on the top, we’re going to try to do the same thing. If we can, we might have to do something different. Did he at least know one arch or the other?
Jolee: We only did the top, but Dr. Fam knew that it could be achieved. He just didn’t know in Dr. Fam’s mind, he was thinking, like, can I do this or am I going to have to send this to Dr. Das?
Bart: Got it. Okay. Ideally, you have the ability to do either one, right? Because Dr. Das is there and Dr. Fam is there. You have the ability to do either one but it’s just nice for you to be able to go into the third ten with some clarity going, hey, this is the treatment plan, you’re a candidate. This is the treatment plan that we’re going to do and you have something to close on. It’s just really tough anytime you don’t have that. And if there is no clarity, let me say, hey, we’re not sure. We’re going to talk to Dr. Das but if Dr. Das is there and they can confer with him while the patient is still there, that’s even better.
Jolee: Yeah. And I do think that day, Dr. Das was in surgery if I remember correctly. Because usually, in that case, if I know prior if this is something that Dr. Fam is not going to be comfortable with, I’ll grab Dr. Das.
Bart: Got it.
Jolee: We just weren’t able to grab him that day.
Bart: Okay, cool. All right. I’m going to go ahead and fast forward a little bit and keep going.
Dr. Fam: I understand. All right. So I’ll have her put that together for us, all right?
Mr. Jones: All right, thank you, sir.
Dr. Fam: No problem.
Mr. Jones: I appreciate you.
Jolee: Thank you, Dr. Fam. All right. I’m going to get a number together for you, okay? Getting at this field, so we’re able to do a discount for our patients. You can have a seat over here with me. So I gave you two permanent options that are obviously permanent, right? Non-removable. Okay? One is zirconia and one is not.
Bart: I would like to have heard him say, hey, on a scale of 1 to 10, this is how important function is. On a scale of 1 to 10, it’s how important maintenance is. I would have liked to get some information from him describing what kind of aesthetics he wants, function, and maintenance. That way, I don’t have to give two options. I can just say, look, based on what you told me was most important to you – function, aesthetic, and maintenance, there’s really only one option that’s going to give you everything that you want, and that’s this. Boom. I will go in with just one option, right? Because there are two options, three options, four options, whatever, it’s all that’s going to meet their expectation post-op. So, I would have liked to get that from him before we give them two options. Because again, if you guys do that, if you give them two or three different scenarios, most likely you’re going to create a situation in which they start comparing and contrasting with price, and even though, they want something like this, they look at the price of each one and they jump into that consumer mode.
So, I want to try to prevent it. I want to get the problem, I want to find out what their vision is for the future, and I want to give them an easy, no-brainer solution that’s extremely compelling with no other options. If they have too many options, they have to think. If they got to think, then we’re going in the wrong direction because a lot of times they’re going to give you the whole, let me think about it, let me go home, this is a lot. I got to figure out which one was right, and so on and so forth.
So, ideally, they treatment plan themself, that’s the whole point of the consultation is that I don’t give them options without a reason, they treatment plan themself, and he’s going to decide whether it’s zirconia or not based on telling me what level of aesthetics he wants, right? How long do you want it to last? How he wants it to function. Okay?
Jolee: Here is everything included with the surgery, the extractions, the sedation, temporary teeth, permanent teeth, bone grafting, you get a two-year maintenance, that’s included, a 10-year implant warranty and then a seven-year warranty for the teeth on top. We do these very often so we’re able to order in bulk. Value-wise, this is what you’re getting at this fee. We’re able to do a discount for our patients. This is going to be zirconia.
Mr. Jones: What’s zirconia?
Jolee: The strong, porcelain, very strong. Okay? This one here, same surgery, everything included. The only difference is…
Bart: It’s a little odd typically also to get all the way to the end and give an option for zirconia when the patient has never heard the word. Right? It happens every once in a while but it doesn’t happen very often. Usually, we’re going through it. I think there was just so much. And a lot of times, the doctors talk about it, I think there was just a little bit of confusion in the second ten that kind of led to this, but it’s definitely a little out of the ordinary to recommend all-in-four with zirconia with the price when a patient doesn’t know what zirconia is. They don’t know what it is. They don’t know why you’re recommending it.
Jolee: Temporaries are like ceramic, almost like denture material. Once the healing is complete, we make you a new ceramic, okay? The ceramic can wear down some later down the road, you may have to have that replaced and there would be a charge for that. Same surgery just a little bit of a different price point.
Mr. Jones: Okay. Thank you.
Jolee: Yes, sir.
Bart: We’re making him decide. Do you know what I mean? Ideally, we just ask him what he wants. It’s easy for them to answer those questions and then we decide for him, right? Yeah, he actually decides but it’s like, hey, surgeries came, what kind of teeth do you want? And he’s looking at it and he doesn’t know what zirconia is, he doesn’t know the differences there, he’s never touched them, hold them, felt them, so he just doesn’t know so it’s kind of a difficult decision for him to make especially when he’s looking at two things he doesn’t know and he doesn’t really understand and then two different price points. Ultimately, I would say, hey, look, there are a couple of different materials we can put on the teeth based on what you want. This is the one that makes the most sense. This material is made out of zirconia, let me show you what it looks.
The reason why we’re going to do it this way, you said, function is the most important thing. You want to be able to play the horn, you wouldn’t be able to eat, you want to be able to chew, and you don’t want to have to worry about it – that’s what this does. It’s very strong, it’s very resistant to cracking, breaking, and also the aesthetics. I know it’s not an important function but it looks unbelievable as you can see right here. And then as far as maintenance, not having something snaps in and snap out, you wanted something as low maintenance and it’s going to last you. So, this is by far and away the best material to use to give you what you want in the future. So, that’s why we’re recommending this. Here it is. Boom. Now, just make that connection.
But if he hasn’t told you, if the patient doesn’t describe what they want in the future, then we’re just going to make some recommendations based on, what? Because like you said, you can do the surgery either way. So if we don’t have reasoning behind why we’re recommending one or the other, they are likely going to default to the price point as one of the most compelling indicators in terms of which one they’re going to choose.
Jolee: Do you have any questions for me? The timing is the same time frame of four to six months in total. It could be a little bit longer.
Mr. Jones: So does that go in steps?
Jolee: No, sir. It’ll all be done at the same time.
Mr. Jones: Is it just one visit?
Jolee: So, you come in to do your stage zero, which is your scanning, your photos, all of that. That’s your first appointment. Three weeks later, we’ll get you in for the surgery. We take the teeth out, place the implants, do the bone grafting, and all of that. We see you for a post-op, which will be your third appointment, and then any appointments that are necessary from the healing from the time of the surgery to the four to six months.
Mr. Jones: And so, when do I get the first teeth?
Jolee: The day of the surgery.
Mr. Jones: This day? Okay. One visit, then we set up surgery.
Jolee: Unless things change when Dr. Das plans your case.
Mr. Jones: All right. That gives me a sense of the timing and this one was the original teeth here.
Jolee: This is going to be the ceramic.
Mr. Jones: And then, there was the placement of these?
Jolee: Yes, sir. You’ll get those at the end once all the healing is complete.
Mr. Jones: So these are the replacements. I have teeth from this.
Bart: Again, it’s kind of out of the ordinary for him to be figuring out all the details after the price, right? And I think, it kind of again falls back down to the second ten – he doesn’t know the timing, he doesn’t know how many appointments it’s going to be, he didn’t really know what the material of the teeth are until after he had the bundles in front of him. Not typically the sequence that it goes. So, typically, the doctor defines candidacy, makes a primary recommendation, and gives an idea of what it’s going to be, then the treatment coordinator will go into the third ten, celebrate candidacy, it’s awesome, you’re a candidate, and then it’s a quick recap, and then it’s the bundle.
Just to make sure, ideally, before I give the person the price, I wanted to make sure that they understand fully what it is that we’re recommending, right? This is what it is. This is what it’s going to provide you. This is how you’re going to look and feel after it’s all said and done. And I got a gain agreement on all of those things, then I present the bundle. That’s kind of typically how it goes. If you go bundle first, a lot of times you get to the point where you’re kind of like re-explaining things or explaining things for the first time when they’re in consumer mode. I want them to conceptually agree with me that this treatment is going to give them everything that they want. That is critical. That you have to do, right? Conceptually, hypothetically, this treatment is going to eliminate my pain points and give me everything that I want in the future. We’re not talking about the price yet, we just agree conceptually that that’s going to give me what I want. You really want to gain agreement on that before you get into the price.
Mr. Jones: I guess, in my mind, this section and timing.
Jolee: And this is the same thing.
Mr. Jones: Pretty much the same thing, only with the porcelain or the zirconia.
Jolee: Yes, sir.
Mr. Jones: And what is the lifetime of this?
Jolee: You get the two-year maintenance, two-year warranty of the teeth, and the 10-year warranty on the implant. This one’s a little bit different. You got the 2-year maintenance, a 10-year warranty on the implants, and then a 7-year warranty on the teeth.
Mr. Jones: Okay. This is like two years on this. Even on the final ones.
Mr. Jones: But those are like 4600 dollars if I’m reading this right? So, if they go bad after the warranty, I would have to pay that or the current price?
Jolee: The current pricing at that time.
Bart: Does this guy strike you guys as somebody with no money? He doesn’t strike me as that. He strikes me as pretty qualified. He’s definitely got something. He’s definitely saved some money here. He keeps his cards pretty close to his vest. Hey, Jolie, when you actually closed this guy, how did the conversation go about money? I know we didn’t get it closed now and he didn’t want to disclose to you what the other practice recommended and what their pricing was but how did it go with pricing? Because he seems to play it pretty close to the vest as far as what he has and what he wants to spend.
Jolee: So, I knew from the beginning that he had had a little bit of savings and it was just a matter of how much of his savings he wanted to use. When he called and told me that he wanted to move forward, I just asked him, I said, okay, well, how are we going to be playing for this? And he said I’ll just cut you a check. And that was it. He paid for it in full. He did end up doing the zirconia.
Bart: Okay. What was the total?
Jolee: 25, I do believe.
Bart: And he didn’t even negotiate on the price, he just cut you a check?
Bart: What do you think the other doctor recommended? I have my guess but what do you think the other practice recommended?
Jolee: I think that the other office recommended all the teeth to come out, but he made it clear that he did not want that because even when he was talking to Dr. Fam, he said, I pinned the other doctor down to agreeing to take the two teeth out doing the pegs and a new bridge. So, he got the other doctor to agree to what he wanted, the patient wanted, knowing that it wasn’t going to last.
Bart: Yeah, I think that, yeah, I was going to say, I don’t think that they recommended All on 4 at all at the other practice.
Jolee: Maybe not. I don’t know.
Bart: I think they recommended a partial or a bridge or some type of band-aid that he wasn’t quite sure about. I don’t think that they actually made a recommendation for All on 4. I think that’s kind of why he got a second opinion. But what’s the plan for the lower?
Jolee: We have not talked about the lower at this point.
Bart: He’s probably going to end up in a denture on the lower.
Jolee: I mean, they’re actually really healthy.
Bart: Are they?
Jolee: Yeah. I mean, he’s got a little bit of infection, but it’s nothing like the top. He’s got only wisdom teeth missing on the bottom.
Bart: Oh, perfect. Okay, great. Well, that’s what I think. And sometimes this happens, when they say that I’ve got savings, but he also said, like, I’m not rich, I do have savings, but I don’t have an unlimited budget here, this or that or the other, this guy just strikes me as a guy that has some money. I don’t think that he liked the treatment plan from the other doctor, whatever it was. I don’t think it was really about price. He doesn’t strike me as somebody coming in, because he got an All on 4 treatment plan for 28, and he was trying to find it for 25. It doesn’t seem like that. It seems like he didn’t like the treatment plan, and that’s a little different than someone coming in that’s straight shopping price. He doesn’t even seem like he’s a price shopper at all, right? He really wanted a second opinion based on the actual dentistry and the treatment plan. So, always keep your eyes open for the differences there because if somebody comes in and they have a treatment plan from three different doctors about All on 4 zirconia, and they’re there to price negotiate, it’s going to be a little bit different than this. This guy just didn’t like the treatment plan for one reason or another and he’s here. So, did you have to follow up with this guy to get them to call back, Jolie?
Jolee: I didn’t because I was frustrated with him. He got back to me a couple of days later. Y’all can kind of tell I was not about him. I think the consult would have been very different but he had made it very clear that he wants to run the show. He called me a couple of days later and so it was two weeks later, he came in on the 13th of October, and by November 1st, he came in to pay everything in full and we started the process.
Bart: Okay. Well, good. Awesome. He’s kind of a no-nonsense kind of guy but, again, the easiest and the most effective way for you all to take control of the callback in pace and lead, sometimes, listen, I’m only here to do what you want. That’s it. I’m here to get you what you want and make sure that you’re happy and you have the quality of life that you want. I’ve got a pretty good idea of how your quality of life has been diminished. I know you can’t play the horn, you obviously can’t eat a piece of pizza, which means you probably can’t eat steak and chicken either, which makes it for a pretty miserable existence, right? So I’ve got a good idea of where you are and I know how you got there. It’s happened gradually little by little, year by year, day by day, so now the only missing piece of the puzzle, what I need to know is what you want in terms of an expectation after this is all said and done. What do you want in terms of aesthetics? What do you want in terms of function? What do you want in terms of maintenance? How do you want to feel? How do you want to live? What do you want out of your teeth?
If you tell me what you want out of your teeth and I understand where you are right now, we’re going to make a treatment plan to get you there. That’s my job. So, I’m going to do whatever you want to do and I’m going to give it to you however you want it, tell me how you want it. And that’s the best way to go especially for people that want to dominate the conversation. The problem is they’re trying to dominate in the wrong way. Talking about treatments or talking about protocols or talking about, oh, I want this treatment, or I want that treatment. No. What outcome do you want? That’s what we’re here to talk about. Because I’ve seen it too. Some patients have a really dominant personality much more dominant than this guy. This guy doesn’t know that much. He didn’t even know what zirconia is, that’s how I know that they didn’t treatment plan for All on 4, right? That’s a dead giveaway.
If he’s hearing zirconia from the first time from you, he didn’t get an All on 4 treatment plan at that other place. There’s no way because he would have heard that term, it wouldn’t have been 100% foreign to him. So, this guy just doesn’t have a whole lot of information but sometimes you guys can have people that come in and they’re shopping and they have a lot of information. They know they want zirconia, they know how many implants they want or need or whatever, they know that their candidates, clinically, and they’re in here shop and price, right? And they just want to talk about the treatment, the treatment, the treatment. The easiest and best way for you guys to get them to regain control is to get them off the treatment and on to the clinical outcome. It’ll help get you into a lot of rapport with the patients as well.
But I think ultimately, you did really good and you obviously did a very good job of disturbing the guy’s complacency. I think if Dr. Fam did one thing really well, I don’t know if this was his intent but I think just telling the guy, man, look, I don’t even know if we can do it, I don’t even know. If we can do it, it’s not going to be me doing it because this is not very straightforward. You’re missing a lot of bone here and we might have to do something totally different. I don’t even know if you’re a candidate for implants. I think that shook him up a little bit because you heard him say, like, well, if you can’t save the foundation, what happens then? Am I done? So, I think, that probably played a big factor in the guy proactively calling you back just because maybe Dr. Fam scared him a little bit with that. The guy was like, oh, crap, I can’t wait any longer for this. I got to get this done. I got to do something. Does that make sense? Okay, cool.
I’m going to get to some of these questions real quick, okay? Let’s see. If you present one option at what point do you give other options if it seems like they can’t afford it? Well, not when it seems like they can’t afford it when they tell you they can’t afford it or they won’t pay for it. That’s all. You got to present one option with the bundle, you show them they’re getting a great deal, that they’re paying 20% or 25% below market value. So, they’re basically getting this at wholesale prices. Oh, I can’t afford it. Right? If they can’t afford it and we can’t get them financed, what can you afford? We don’t even switch to treatment. Once they can’t afford something, the conversation only switches to what they can afford and we get a dollar amount. Once we get the dollar amount, then we’ll change the treatment plan. But you don’t want to give a treatment plan, oh, I can’t afford it. Okay, well, maybe we can do this. Nah, I still can’t afford it. Okay, maybe we can do this. Nah, I still can’t afford it. No. It’s like once I can’t afford it one time, then it’s like, okay, what can you afford? And then we’ll back into changing the treatment from there. How much do you have to put down, and then we have to determine their creditworthiness and all that stuff, but that’s typically when you do it.
Let me see if there are more. I would love to see one of these words of a price shopper and how to handle that. We got tons of those. Yeah, Jolie, did he have additional questions when he called? Did he just call and just come in and give you a check? Or did he have any additional questions?
Jolee: Yeah. He called and he said, I want to get started. I was like, okay, well, what do you want to do? And he said I want to do the zirconia, the more expensive one knowing that all the teeth needed to come out. So, on the phone, I reiterated again, I want to make sure that you know all the top teeth in the back are coming out. He said, yes, we got him scheduled, and then at that point when he came in for consent and payment, and for stage zero, Dr. Das at that time, went in, I introduced Dr. Das, and gave the handoff. He went over all of that and said, hey, look, you this is great, we can do this, and Dr. Das worked his magic, and celebrated everything, gave him all the green lights, and we did the surgery. The patient was happy.
Bart: Awesome. Awesome. Okay, let’s see, Joyce has a question here. All right, Joyce. Let’s see. I closed All on 4 last week and proceed to payment, and we started all records and scheduled surgery in five weeks for 30k. The patient called yesterday and said she changed her mind and could not afford monthly. I will see her this afternoon to discuss this. What do you think? How should I handle this? Where’s Joyce? Joyce, are you on here? I can’t see you.
Joyce: Hi, I’m here.
Bart: Okay. Hey, Joyce. So they already signed for proceeds. You guys already got full payment.
Bart: Okay. You got full payment, now, she’s saying she can’t afford the monthly. So, she’s coming today.
Joyce: Yeah. She said that when she signed up, she expected her parents to be helping her with the monthly payment, and I guess the parents actually told her that they were not going to be helping. What we told her was the doctor worked on her case over the weekend with the lab and we took all the records, everything got started already, so I told her that there were services that we did that there’s a charge for it. So, actually, putting together everything with all the records, we ordered the surgical guide, or the lab is in the process of making her provisional prosthesis. I have a little idea of what am I going to do, I was thinking of letting her know, first, what is she thinking about her monthly payment that she can afford and if it is going to be within her budget, I was thinking to just talk to her about doing the 20,000 for now with proceed and then after between 9 to 12 months that she’s going to be on provisional, I can tell her that she can give the 10,000 when we take the impression for the final prosthesis.
Bart: So, let me ask you a question – how far out did you spread her payments with proceeds? How many months?
Joyce: 120. So she got the longest one.
Bart: Okay. So, she got the longest one, what’s her payment?
Joyce: Yeah, I can go right now and check.
Bart: Because here’s going to be the tell-tale, right? Because you never know what’s going on. They could have had second thoughts, gone and got a second opinion, and got it for 24, not 30, right? And she could be making this whole thing up, but there’s a difference between, hey, I can’t afford, let’s say the payment is 550.
Joyce: Her payment is 559.
Bart: Yeah. Okay. Her payment is 559 and she’s saying, hey, I can afford 450, or I can afford 350, or is she just saying I can’t afford it because now her parents aren’t helping her? Does that mean I can’t afford anything? If it’s nothing and it’s zero, then it almost makes me feel like it’s not the money. Do you know what I mean? Because if they were going to help her with the payments, was she expecting them to make all of the payments for her?
Joyce: Well, I don’t think so because she’s a nurse. She was ready to go that day. It was an easy close.
Bart: Really? You closed there.
Bart: So, sit her down, talk to her, and when she comes in, the first thing to do is reiterate why we’re doing it and how important it’s going to be. You reiterate it. Do you know what I mean? You say, hey, let’s just start from zero here, okay? Because we’re going to work this out. Whatever we’re going to do with the money, we’re going to do it, and we’ll figure it out, I will help you figure out the money but what we’re not going to do is continue living with no teeth, not being able to eat. You know what’s going to happen if we do nothing. It’s just going to perpetuate, it’s going to get worse and worse, and it’s going to be horrible for you to live like that. We’re not going to do that. I’ll figure out the money, but we’re going to fix that. Okay? So let’s talk about the money and then I would just get into it and ask her. Hey, what’s going on with the finances? Right? Right now, you’ve got it spread over 120 months, it’s $559 a month. How much can you pay? I would just ask her. Ask her and see what she says.
If she says, I can’t play anything, then that leads me to believe that I probably need to work on reselling it because she can pay something, do you know what I mean? As you said, she’s a nurse. She has the ability to make a payment. So, if she says she can’t pay anything, then now, I have to loop. I would do the loop immediately, right? Because now I got to figure this out. So I would loop and I’d say, okay, listen, let me just ask you a question. Does the treatment plan itself makes sense? I mean, based on where you are now and everything that you’re going through, and where you want to be, does the treatment plan make sense? Do you want the treatment? Does the treatment make sense? Forget about the money. Forget about all that stuff. Does the treatment make sense to you? That’s what I would do. If she says, I can’t afford anything, I would immediately loop. I’ll be back in the sales call because, yeah, she can’t afford anything. If she was sold on the treatment and she would be working with you go and look, it’s 559. I can’t afford 559, I’ve got fixed expenses. I could probably do something like three.
That’s a person that’s sold. He’s looking for an option, a way forward. If she goes, yeah, I just can’t do anything, I can’t afford anything. That person is looking for a way out the door. I’ve got to do the loop and figure out where did I miss her. What happened? Do you know what I mean? So, if she says, I can’t afford anything, I’d run the loop. If she says, I can afford 300, then you start looking at possible solutions like what you said – taking it from 30 to 20, maybe you phase into the treatment, do it in two phases, what if you start off giving her options with phasing and different money. If she’s looking for a way out, then she’s not going to accept anything anyway. Do you know what I’m saying?
Joyce: Uh-huh. Okay.
Bart: That’s how I would handle it today. Give me a call and let me know how it went, too.
Joyce: Will do.
Bart: Okay. Yeah. Does anybody else have any questions related to the video or to anything? Whoops, I got another question right here. No question, okay? Does anybody else have any questions before we adjourn for the day? We had an awesome power session last week, you guys. We’ll get out the schedule for next year. There are six different power sessions. Each session is held twice, so every six months, it turns over, but make sure that you guys get on the schedule. Get clear water with your team for the power sessions. We got a boot camp coming up in February. I really look forward to seeing everybody there. So get it scheduled that way you’re not doing it last minute. And remember when you schedule if you say, hey, I’m coming to the power sessions, it’s going to be me and two other people, don’t show up with ten other people, right? Because it is in our facility, we have a certain cap that we can’t go over. So, make sure that when you RSVP, everyone’s RSVP’d and if it’s RSVP’d for one, then you got one. If it’s two, you got two. But if it’s one, don’t bring six or seven. We got a little issue with that last time.
If not, I will see you all at the next power session and we’ll get ready for the peer mentorship call here in a couple of weeks. All right. Go close some arches.
Jolee: Thank you.
Bart: Okay, get them.
Joyce: Thank you, bye-bye.
Bart: All right. Good job.