When a dental patient considers care for a procedure like a new crown or a root canal and can’t pay for it up front, it’s time to check what may be a set of financial contradictions.
They may have a steady income, a clean payment history, but no conventional credit file to show for it. To a traditional lender, they’re invisible. To the practice, they’re a treatment plan about to walk out the door.
That doesn’t have to be the case. Although dental work rarely arrives when a budget has room for it, small practices have long lacked the tools to bridge that gap.
That’s changing. Saving enough to pay for dental care upfront can be challenging but financing partnerships now let small practices offer patients the same options that the big groups do, treating cost as something to solve before the treatment is discussed rather than a reason to walk treatment back.
In a conversation with PYMNTS CEO Karen Webster, Synchrony Health and Wellness CEO Beto Casellas and oral surgeon Dr. Priveer Sharma of Sharma Oral Surgery described financing as a tool that preserves access to care with the peace of mind that a consumer can pay for it overtime.
The Patients a Credit Score Misses
The patient who can’t pay up front often isn’t a credit risk at all. More than 45 million Americans are credit invisible, Casellas said. They lack the conventional credit histories traditional lending models rely on, even though many hold steady jobs and pay their bills on time. A financing decision built on a credit score alone turns a payable patient into a declined one.
Synchrony has invested in alternative underwriting that weighs broader indicators like payment behavior and cash flow rather than leaning on a single credit bureau snapshot. For the patient who initially reached out to the doctor’s office that can be the difference between an approval and a treatment plan deferred indefinitely.
The implication extends beyond one company. As healthcare financing develops, lenders are likely to experiment with richer data that recognizes responsible behavior outside conventional borrowing. Expanding access without weakening credit discipline could be one of the defining competitive questions of the next several years.
Underwriting decides who can be offered financing. How it’s presented decides whether they accept it. Sharma, whose Charlotte, North Carolina, practice handles wisdom teeth, implants and reconstructive work, said patients decide through a “relative value equation.”
“We really have to spend a lot of time talking to patients about education and creating value for why they’re doing something so they can appreciate the reasoning,” Sharma said.
Most patients in his office are trying to prevent future problems, not respond to immediate pain, he said.
Every purchase weighs benefit against cost. In dentistry, that means helping patients understand what preventive treatment avoids before discussing how to pay for it. Wisdom teeth often come out before pain develops, making education as important as the surgery.
“My role as an oral surgeon is creating that value proposition so that by the time we start talking about cost, we can use financing as an option,” Sharma said.
That shifts financing from a rescue mechanism to part of the initial consultation. Instead of presenting a large bill and waiting for resistance, financing becomes another way for patients to weigh how treatment fits their priorities.
Webster drew a parallel to online shopping. Patients now expect to see financing choices alongside the total cost
Planning Is Rare, Even When Treatment Matters
Most patients simply don’t prepare for dental expenses. Synchrony’s own research found that 75% of consumers don’t save in advance for dental procedures, and more than 1 in 4 postpone care over cost.
That’s why financing has become intertwined with preventive medicine. A patient who delays treatment over cost often needs more extensive treatment later.
“We see that as making care more accessible and obviously making it more affordable,” Sharma said. “This is a support tool. Not a barrier to care.”
Why the Cost of Financing Is a Small Price to Pay
Sharma’s most practical point concerned what happens when financing enters too late. Patients who can’t comfortably afford treatment start removing pieces of recommended care to hit a lower price, “nickel and diming” procedures until the clinical objective is compromised.
Presenting financing from the outset changes that. Patients can weigh monthly affordability without dismantling the plan. For the practice, the merchant cost of offering financing creates more options for payments. It’s what converts a patient who can’t pay up front into an accepted plan on the spot and keeps the full course of care intact, rather than watching it shrink to whatever the patient can pay that day.
Financing creates benefits beyond affordability. As Webster put it, “It also creates trust, which is a tangible intangible.” Solving the payment problem can strengthen referrals and reputations as much as clinical outcomes do.
That’s where the gap between small and large practices closes. Big groups have dedicated administrative staff to handle financing. Sharma said a financing partner gives an independent practice the same reach, the same ability to give their patient the treatment they want without building that infrastructure. For an independent practice, that’s the difference between competing for a case and conceding it.
