Page 19 - Bulletin Vol 28 No 2 - May - Aug. 2023 FINAL

Article| Avoiding Patient Disputes

A Plan Upfront Will Avoid Problems Down the Road

By Gene Porcelli

It’s not surprising, most disputes that arise between patients and their dentists come from fee disputes.
More specifically, the problem is often due to miscommunication about treatment costs and dental plan
coverage. At the dental society, we get several calls per month from patients looking to lodge a complaint
against a dentist and it’s usually about a surprise bill and not a treatment complaint. However, it is not
uncommon for that fee dispute to escalate into a treatment complaint that can lead to a peer review or
malpractice case.

After thirty-eight years in practice, over twenty-five years of reviewing malpractice claims and now over
three and a half years as Executive Director listening to these calls, I would like to suggest some ways to
avoid these frustrating, annoying, and time-consuming situations.

First and foremost, create a written treatment plan. And I don’t mean scribble something on the back of
your business card. Create and print a complete and legible treatment plan that not only lists what you
plan to do but explains the procedures in language understandable to the patient. This will not only help
you avoid misunderstandings with the patient, but it can also prove invaluable in the defense of a
malpractice suit. Take the time to go over everything with your patient prior to beginning any work. Make
sure they understand the “what” and the “why” as well as any alternatives and possible complications or
alterations to the plan as treatment progresses. This is time well spent since informed consent is not only
required legally but having it will avoid the need for awkward or contentious conversations down the road.

The next step is an accurate explanation of fees. Provide a list of every treatment to be performed with the
associated fee. If you are a participating provider, you should list your normal fee as well as the
“discounted” plan fee so the patient can see the difference. Again, this should be in writing. If it’s a large
or complicated treatment plan, get a pre-determination from the dental plan. Yes, this may delay the start
of treatment, but it will go a long way in avoiding any misunderstanding. As we all know, sometimes the
information we initially get from the plan changes when it comes time to send in the claim. Having a
written pre-determination from the dental plan, a copy of which should go to the patient with the
treatment plan, will take the blame off you and your staff and place it with the dental plan, thus avoiding
any problem if the actual amount paid is different than what was originally presented.
Finally, you should provide the patient with a schedule of the expected payment at each appointment. You
are not a bank. I do not recommend you allow the patient to make payments beyond the expected
timeframe of the treatment. If they need extended time let them use their credit card or offer the use of a
healthcare financing company such as CareCredit. Once you have presented to the patient, in writing, a
treatment plan which includes the cost of treatment, and a payment schedule, have them sign it. There
should be a statement included just above where they sign with words to this effect:

“I have been presented with the treatment plan, estimated cost of treatment, and a payment schedule.
Everything has been explained to me to my satisfaction and I have been given the opportunity to ask any
questions and satisfy any concerns I may have. The benefits, risks, and alternatives have been explained
to me, including doing no treatment at all. I also understand that sometimes in the course of treatment
situations may arise that require additional treatments not originally planned for and that this may
result in additional charges not originally presented. I understand that the “insurance” benefit is only an

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Nassau County Dental Society ⬧ (516) 227-1112 | 19