Most orthodontic practices don’t struggle with case acceptance because of a lack of effort, they struggle because the process around the team isn’t built to convert consistently.
In a recent conversation with Dr. Colby Gage, a board-certified orthodontist and founder of LevelUp Orthodontics, and Michelle Heitland, office manager at the practice, we unpacked what actually drives stronger case acceptance, not just in theory, but in the day-to-day reality of running consult exams, presenting financials, and helping patients move forward with treatment.
So when you hear a number like a 68% case acceptance rate, well above the industry average of 40-50%, it’s easy to assume it comes down to a great treatment coordinator, better scripts, or more follow-up. Behind the scenes, it’s something else entirely.
It Starts Before the New Patient Exam
Case acceptance doesn’t begin when the treatment coordinator sits down with a patient. It begins before the patient ever walks in, and in many practices, that prep simply isn’t happening:
- Insurance hasn’t been fully verified ahead of time
- Payment options are built on the fly
- Patients don’t know what to expect financially
- The consult feels like the first time they’re hearing everything
That creates pressure in the exam room. Patients are trying to process clinical information, cost, and timing all at once. And when that happens, the most common response is, “I need to think about it.”
High-performing practices reduce that friction before the exam even begins. They walk in with insurance already verified, clear financial ranges in mind, and a patient who’s prepared and confident. That changes the entire tone of the conversation.
Financial Conversations Feel Different
One of the biggest differences between average and high-performing orthodontic practices is how they approach financial presentation.In more traditional workflows, down payments are fixed, monthly options are limited, and the conversation feels rigid, so patients have to adjust their budget to fit the practice.
Dr. Gage was direct about what wasn’t working:
“We required everyone to pay 20% down, which, for some people was a pretty big detriment. Our conversion rate was a lot lower. We didn’t give patients a lot of flexibility on choosing their monthly payments. Patients had to bend to what we wanted, and it just wasn’t working.”
In higher-performing practices, the structure is different. Monthly payments are flexible, options are presented clearly, and the conversation feels collaborative. Instead of: “Here’s what it costs,” it becomes: “Here’s how we can make this work for you.”
The Role of the Treatment Coordinator Changes
When the system isn’t working, treatment coordinators are asked to do everything at once, verify insurance, estimate benefits, explain treatment plans, walk through monthly payment options, manage pending patients, and keep the schedule full with starts, all within a single consultation and a packed schedule. That’s not sustainable, and it’s not where treatment coordinators do their best work.
In practices seeing higher case acceptance, the role shifts. Because key pieces are already handled upstream, the treatment coordinator can focus on building trust with the patient and parent, reinforcing the value of treatment, and guiding the patient toward a confident decision, not scrambling to calculate numbers or recover confusion.
Why Strong Ortho Practices Don’t Rely on Follow-Up to Convert Patients
In many practices, follow-up carries a lot of weight. When patients leave without starting, the assumption is that a call or text will bring them back. But if the patient left unsure about cost, timing, or value, follow-up becomes a long cycle of outreach, and then silence.
High-performing practices don’t rely on follow-up to fix the consult. They use it to finalize the start, because during the exam, the system already set expectations, addressed financial concerns, and built confidence.Follow-up sounds less like “Do you have any questions?” and more like “Let’s get you scheduled.”
The Difference Isn’t Effort. It’s Design.
When case acceptance is low, the instinct is often to look at the team: do we need better scripts? More training? What becomes clear when you look inside higher-performing practices is this: even strong treatment coordinators struggle in systems that create friction.And when the system is designed well, good teams consistently perform at a higher level.
What 68% Case Acceptance Really Represents
A 68% case acceptance rate isn’t just about closing more patients. It reflects a practice where patients understand their options before they leave, financial conversations feel manageable, the consult is structured and consistent, and the treatment coordinators are set up to succeed. It also means fewer patients sitting in a “pending” status for weeks, and more patients moving confidently into treatment.
That upstream system — insurance verified early, flexible financial options, a structured consult — is exactly what OrthoFi’s case acceptance platform is built to run.
Ready to hear how Dr. Gage and his team built this system? Watch the full conversation with Dr. Colby Gage and Michelle Heitland. Or book a discovery call to talk through your practice’s own numbers.
