The following will attempt to answer some of the common misconceptions:

If the patient does not pay their bill, am I still obligated to complete their treatment?

The short answer is yes.  You cannot withhold care for lack of payment.  When a patient of record presents in pain, you must treat the immediate situation regardless of whether the patient has an outstanding balance or not. 

If money is due while the patient is undergoing treatment, the best advice is finish the treatment started and then consider your options to collect your fees.

Occasionally, receiving a statement for services serves as a catalyst that provokes litigation.  The statement for services in hand is sometimes the patient’s first opportunity to consider the value of the treatment delivered.  Withholding payment or disputing the amount of the fee are frequently used as a way to express dissatisfaction with the outcome of treatment. 

How these disputes are handled often dictates their outcome.  It is important to distinguish patients who have legitimate concerns from those who are just trying to negotiate the fee after the fact.  It is suggested that the office call the patient before too much time has elapsed, as there may be a legitimate reason for the payment delay.

When a patient expresses displeasure when asked to settle a past-due account, it is a good strategy to offer to see the patient in the office at no charge to address the matter.  This enables you to determine whether they have a legitimate complaint.  If the patient refuses to be seen, it is advised to send a letter asking whether the past-due account is the result of treatment or unsettled questions.  A letter of this type makes it harder for the patient to later allege that you did not care.
If the patient’s complaint is real, the practitioner can correct the problem(s) or refer the patient to a colleague or specialist for a second opinion.  If additional fees are involved, the patient must be immediately notified, but it is best to waive additional fees, if possible.

If the patient expresses a complaint that is not legitimate, usually this can be cleared up by meeting the patient face-to-face.  When meeting with a disgruntled patient, keep in mind that an exaggerated reaction to a collection notice can result in a malpractice claim.  The practitioner needs to be prudent and evaluate the patient correctly.

Am I required to give the patient a copy of their records?

The short answer to this question is yes.  While the original record is the property of the practitioner, state statute requires that a patient request for a copy of the records must be met regardless of whether the patient owes the practice money.  Never, never release any part of the original record to the patient --- this includes radiographs and models.  Never ever.

A past-due account is not a legitimate reason to deny a request for a copy of the record.  Debt collection is a separate matter.  The practice must make reasonable arrangements for transmitting the record to the patient in a reasonable time frame.  Reasonable costs to duplicate the records may be charged.  The operative word is “reasonable.”   The copy charge cannot be punitive, retaliatory or discriminatory and may be prescribed by state statute.  If in doubt regarding charges, contact the state licensing authority and also ask what your obligation is if the patient refuses to pay a reasonable charge.

Consider using an Authorization for the Release of Dental Records that may be available through the state dental society, your insurance carrier or your attorney before releasing records.  It is always a good idea to document the transfer of records.

After a patient has been referred to another dentist, who is responsible for the treatment outcome?

The practitioner making the referral has the responsibility to refer the patient to a competent individual who will practice at the standard of care.  Today, generally specialists will keep the referring doctor informed of the patient’s progress.

The patient record should reflect the reason for the referral, who the referral was too, when treatment was completed, what was the outcome and was there follow-up treatment.

Maintaining continuity of care is important.

What do you do if things don’t go as planned or there is an adverse outcome?

We like to be in control, but when things don’t go as planned, it is important to be open and honest with the patient.  You must take immediate steps to resolve the situation and ensure the patient’s needs are met.  This helps maintain trust and the doctor-patient relationship.

Informing the patient immediately may mean stopping treatment and explaining the situation with them.  If an error or mistake is discovered after the patient has left the office, they should be contacted right away.  Unexpected outcomes and surprises often anger and frustrate the patient, especially if they perceive they have been lied too.  Patients file lawsuits when they have been angered and believe they have been lied too.  Giving a truthful explanation and answering questions honestly goes a long way towards quelling hostility and preventing a lawsuit.  Be compassionate and professional.  Warm and fuzzy always wins.

If you experience an unanticipated adverse outcome:

Contact your professional liability carrier for instructions.  Keep the documentation of this contact in a separate file, not in the patient’s record.  If in the patient record, if there is a lawsuit, it would be discoverable.

Speak with the patient immediately.

Inform the patient of the situation and offer solutions to resolve the matter.  Be professional, honest and positive.

Be compassionate but avoid using terms that could be construed as an admission of guilt.

Document the incident and your course of action to resolve the matter.

Giving a refund is an admission of liability or guilt.

Parties can agree to disagree.  Refunding a fee does not mean guilt, negligent treatment or liability.  By doing so, parties in a disagreement are able to move forward.

The key is communication between the doctor and the patient.  It should not be done in a hostile framework.  The best way to do it involves writing a letter outlining the treatment plan that the patient agreed to, the results and other facts, including your decision to make the refund.  In the letter, the reason for the refund should be in the “interest of compromise and goodwill.”

If a refund is the mutually acceptable solution to an unpleasant result, you have to determine whether a third party paid any portion of the fee.  If so, the doctor’s office needs to refund the insurance portion to the carrier.  Call the carrier for the proper protocol for refunding that portion of the fee.  This will make the benefit again available to the patient.  Patients cannot profit from receiving the total fee if a portion was made by the insurance company.

For further information, see the article, “A Patient Refund Does Not Admit Liability.”

Debunking common practice myths

© Gary Inglese

Dental Defense - Illinois Department of Financial and Professional Regulations Defense - Dental-Legal Issues - Dental Risk Management - Dental Contracts and Business Issues - Dental Office Transitions

Practitioners strive to run their practices making logical and rational decisions regarding employment issues and patient care problems. While practice owners think their actions are acceptable and think they are acting within the confines of the law, sometimes the opposite is true.


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