Complaints and legal claims can add stress to the practitioner’s life, disrupts and detracts from the provision of services, adversely affects the practice’s reputation and the legal costs in responding to the complaints and / or legal claims often exceeds the fees sought to be recovered. As a consequence, formulating and adopting risk management strategies should be an important component of any practice’s operations.
Risk management strategies
There are a number of risk management strategies that a practitioner and practice can employ to minimise potential disputes with patients and/or to avoid being sued or being made the subject of a complaint.
Setting fees that the majority of practitioners would consider acceptable
Whilst the setting of fees is a task for the practitioner taking into account their practice costs (including wages for practice staff, rent, electricity, equipment, continuing professional development, practitioner registration and professional indemnity insurance), the patient has a right to expect that the practitioner is behaving with fairness, integrity and honesty when setting his or her fees.
The setting of unacceptably high fees not only can adversely affect the practice’s reputation and therefore business, but lead to higher levels of patient dissatisfaction and therefore, unpaid fees for services rendered.
Obtaining informed financial consent
It is critical that patients are given clear information regarding the scope of their care and treatment and possible variations to those services, if clinically indicated, before the services are rendered. Further, it is imperative that clear information is given relating to the cost of these services by way of accurate estimates of relevant fees and potential additional fees in the event that the planned service is changed for clinical reasons. It is best that these discussions are conducted in private to respect a patient’s dignity and privacy when dealing with the financial aspects of their care. Moreover, it is important that the information is provided in plain English with dental jargon kept to a minimum, or at least clearly explained to the patient in plain English, to minimise any disputes as to what was discussed and agreed upon. Whilst patients are responsible for actively participating in these informed financial consent discussions, asking the patient expressly whether he or she has any queries regarding what has been discussed to ensure the discussions have been understood, is a small but important step to take.
The ultimate agreement reached between the practitioner and the patient in relation to the scope of treatment and the associated fees should then be recorded in writing and a copy given to the patient for his or her records.
Publication of a billing policy for the practice
Adoption of a billing policy can alleviate stress and confusion for both the practitioner and the patient. A billing policy is a document that sets out the practice’s general rules regarding billings. Such policies often include information regarding when payment is required, any discounts available for early payment or charges for late payment, acceptable forms of payment and the name and contact details of a person who can be contacted to discuss payment related issues. Billing policies should be documented and readily made available to patients either on the practice’s website, via a leaflet or published in a prominent place at the practice.
Performing a cost-benefit analysis before pursuing unpaid fees
Prior to initiating legal action to recover unpaid fees, it is beneficial to conduct a cost-benefit analysis in regards to the debt recovery. Review the patient’s file in order to ascertain what treatment was performed, whether any complications were encountered in regards to the treatment, what fees were quoted and consider the possible reasons behind the patient’s non-payment of the fees.
Generally, outstanding fees are more likely to be successfully extracted from patients who were happy with their treatment. Unhappy patients are more likely to respond to a request for payment with a counterclaim alleging negligence or a breach of contract by the dental practitioner. Therefore, it is vital that the practitioner identify whether the patient is dissatisfied with the treatment received and why. A patient may be unhappy if he or she considers that he or she underwent treatment that failed, the treatment was unnecessary, or he or she was charged for treatment that was not provided.
If the cost, effort and impact on the practice’s reputation in recovering the outstanding fees are disproportionate to the fees owing, it may not be worthwhile pursuing the unpaid fees.
Effective and regular communication about the treatment and costs
Throughout the patient – practitioner relationship, it is important to maintain clear communication about what treatment is necessary and why, the expected outcomes of the treatment and the costs so as to prevent any misunderstandings and to manage expectations appropriately. Providing regular updates to the patient of their treatment progress and any alterations that may affect the overall cost of the treatment, as well as interim billing will assist in managing expectations, preparing the patient for their financial obligations and thereby, reduce the prospects of patient dissatisfaction and patient complaint.
Proactive exploration and resolution of unpaid services fees
A genuine attempt by the practitioner to understand with empathy and patience, the underlying reason why a patient has not yet paid a service fee invoice may obviate the need for legal action to be taken to recover the unpaid fee. Often misunderstandings between the practitioner and patient can be avoided if the channels of communication between them are open, clear, compassionate and empathetic. Records of face-to-face conversations and telephone discussions with the patient regarding unpaid fees should be kept by the practice for evidentiary purposes should the matter proceed to legal action being taken.
Preparedness to have respectful, difficult conversations
The practitioner needs to be prepared to discuss issues of non-payment of service fees with the patient in a direct but respectful manner. Whilst it is important that the patient is reminded of his or her legal obligation to pay for services rendered and the potential consequences of not doing so including cessation of the treating relationship, the practitioner needs to do so tactfully and respectfully. At all times, preservation of the patient-practitioner relationship must be the priority.
Conclusion
An essential skill of any practice is the ability to deal sensitively and strategically with patients who have not paid their fees for services rendered. This requires the practice’s staff to develop and refine their communication skills with patients and to implement a number of risk management strategies relating to fee setting, fee agreements and fee collection. Dealing appropriately and strategically with patients, who have not paid their fees, will improve the practice’s profitability, reduce complaints, can improve patient satisfaction, can lead to new patient recommendations and allows the practice’s dental practitioners to continue providing care and treatment to their patients instead of spending their time in a court room dealing with a patient’s counterclaim.
The content of this article is intended to provide a general overview and guide to the subject matter. Specialist advice should be sought about your specific circumstances.
