I really don't like being "nickel and dimed" and I guess that probably shows in my practice philosophy.
For instance, since DAY 1 in my practice (20 years ago I hung my shingle and started from scratch), I have never charged for records, radiographs, recall exams, initial exams, extended treatment, broken brackets, replacing or repairing a wire on a visiting out of town Ortho patient, and many more items. Do I think it's wrong to charge for those things? NO. Believe me, I've listened to many consultants, etc, who told me my time is too valuable to be giving it away and patients need to be kept mindful of that value by being charged a fee.
In fact until about 5 years ago I didn't even charge for lost retainers unless the patient lost over 10 or so! You don't think that drove my staff crazy? I finally began a policy where patients would receive 2 free retainers if they lose them (or don't wear them so they don't fit anymore) and after that we charge $75 each. I still don't charge patients if they are just worn out. I figure if they wear them so well they're worn out I'll reward them by replacing them at no charge.
So, that certainly is a lot of lost income, right? And I'm probaby being taken advantage of quite often, right? Absolutely! I mean, our time IS VALUABLE and we shouldn't be giving away this stuff for free, RIGHT?
Well here's the way I look at it.
I'm a big ticket guy. I'm asking these families to pony up 5k for braces. And what I want is EVERY single person I come in contact with who needs and desires braces to pay me 5k for it. But I also want them to know that I appreciate them spending that kind of money for my services and I don't take it lightly. In fact, I want them to know that if they commit to spending that kind of money with me that I'll take care of them. I'll see them for recall for 4 years and 4 panoramic films and not charge them a thing. If they break several brackets I'll needle them and if it gets worse we'll have a chat with parents about extending treatment time, etc. But I don't charge them extra. And if they come in my office 10 years after debond and want a replacement retainers because they've worn them out I'll replace them at no charge.
Know why? What happens 10 years after your braces are off? Families get started, friends ask who that nice Orthodontist is, families of 6 come in for initial exams and records knowing that they won't be charged initially. Sisters move to town and have braces-age kids and get recommended to that "nice Orthodontist."
So for me, it's about selling the value of a five thousand dollar case to new patients, not supplementing income from existing ones. It's about Goodwill and the value that creates for your practice when your patients discuss you and your practice to others in the community. To me, that Goodwill has been priceless!