How to Mitigate Potential Fee Disputes

A fee complaint is generally the aftermath of a more significant issue with the patient’s overall satisfaction with their care, you as their dentist, and how their grievances have been handled.

Any customer complaint handling plan aims to intervene before the customer feels their only recourse is a board action or lawsuit. Early identification of the dissatisfied patient interrupts the accumulation of complaints and possible filings of a lawsuit or board action.

Intercepting patients before they go outside your office to address their complaints is the paramount goal. Always attempt to address grievances with a sense of urgency.

The precipitating factors of complaints generally, and fee disputes can be:

• Poor communication is the biggest factor - an effective informed consent process can help to identify non-compliant patients, as well as set realistic expectations
• Information or misinformation patients discover on the internet
• Patients reading social media posts suggesting “this should not have happened” in reference to a complication of treatment
• Poor result (whether real or perceived)
• Post-treatment pain and complications
• Timely access/attention to post-operative care following a complication
• Office personnel or practitioner conduct when confronted with an unhappy patient
• Treatment plans and fees not fully discussed
• Patients feeling like there's no pathway to resolve their issue(s) internally, so they turn to other avenues

Communicate with the Patient & Establish an Informed Consent Process

How and what you communicate to your patients is pivotal in avoiding confrontation regarding fees and complications. You have an ethical and legal obligation to obtain the patient's informed consent. Besides the risks, benefits, and alternatives, an informed consent conversation should also focus on treatment costs and expectations.

The consent process must include honest and forthright information regarding fees. What do those fees cover, and what is not included?

• Provide cost estimates in advance: Provide the patient with a written estimate of the cost of their treatment before they begin.
• Use precise language: Use plain and simple language to explain the cost of the treatment. Avoid using technical terms that the patient may not understand.
• Be transparent: Be open and honest about the cost of the treatment. Explain any additional fees that may be incurred and why they are necessary.
• If you offer payment options: Discuss the options available to the patient, such as insurance, financing, and payment plans. Explain the pros and cons of each option.
• Review the patient's insurance coverage: If the patient has dental insurance, review their coverage and explain what their insurance will and won't cover.
• Be respectful during fee discussions: Remember that patients may be sensitive about the cost of treatment. Respect their concerns and answer their questions as fully and honestly as possible.
• Document the conversation: Document the patient's agreement to the fees in their dental record for future reference. This can help prevent any surprises and set realistic expectations.

Documentation is Always Important 

Documentation should include any warranties being offered and what is covered and excluded. The informed consent process should serve to temper the expectations that the patient should or should not have about the outcome of the treatment and its cost. Always be mindful that patient’s expectations are usually unrealistic. When engaging with a patient in a high-cost, complicated, and esthetic-driven treatment plan, take time before starting treatment to allow the patient to fully absorb the information you provided in the informed consent process and ensure they understand what they are agreeing to.

Disputes will arise despite your best efforts to inform the patient thoroughly. The patient will often demand a fee refund or retreatment at no cost. How you handle a tense situation will many times affect the outcome. It is always preferred that the treating doctor personally lead this discussion (especially when the complaint is about treatment) with a witness present.

Try to Diffuse the Situation & Be Empathetic

Put yourself in your patient’s shoes. Try to see the situation from their perspective. The mere fact that they raised the concern means it is important to them. Your initial response should be face-to-face or a phone call. Using email or text feels impersonal, and also creates a “record” that is later discoverable. Be empathetic and avoid being defensive, no matter how unreasonable or spurious the complaint may seem. Your goal should be to diffuse the situation.

Always allow the patient to state the problem completely, without interruption or argument. Accept the patient’s feelings/opinions. Telling a patient their feelings or opinions are wrong only escalates the conflict. Show real concern and empathy. Ensure the patient feels their grievances have been heard and understood. Assure the patient their grievance will be fairly handled. DO NOT make any promises to the patient.

It is of utmost importance to intercept patients before they leave your office premises to tend to any grievances they may have. Approaching grievances with a profound sense of empathy and urgency is highly recommended.

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Disclaimer: The information contained on the DentistCare Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. All information contained on the blog is subject to change.