Alison Large explains how to reduce misunderstandings surrounding dental fees.
Dental fees can often be a source of frustration for patients and consequently, a cause for many complaints. Common dental fee complaints include: a lack of clarity as to whether certain treatment items are available under NHS arrangements, being asked to pay privately for treatment that the patient was expecting to receive under NHS arrangements, concern that the actual cost of treatment was higher than expected; and, anger about being charged for treatment that the patient believes has not achieved the desired result.
Consequently the following advice may be useful in avoiding complaints about dental fees.
Provide a treatment plan that includes costs
The GDC states that you must give a patient a written treatment plan, or plans, before their treatment starts. There are NHS contractual requirements to provide patients with treatment plans that you must follow.
Ensure the treatment plan has been agreed and signed by the patient, and a copy kept in their records. Not only does agreeing with a patient the fees associated with a proposed course of treatment play a key role in the consent process, it can be useful evidence in the event of a dispute or investigation relating to fees. A treatment plan should include the cost of treatment and whether the patient has chosen to receive treatment on a private basis.
Ensure pricing information is accessible to patients
Make sure you are clear about the services you provide at your practice and the costs associated with treatment, payment arrangements (ie whether you expect patients to pay for their treatment up front or on completion), whether you accept NHS patients or provide treatment on a private basis only. It is an NHS requirement to display an NHS charges poster in a prominent position and a good idea to have available an NHS dental charges leaflet – these are available from NHS Business Services Authority.
When charging for private treatment, the GDC recognises that ‘there are no set limits on what practices can charge for private dental treatment and prices will vary from practice to practice. However dental professionals must make sure that a simple price list is clearly displayed in the reception or waiting area of the practice….and on their website.’
The GDC states that the price list should include a list of basic items, including:
- A consultation
- A single-surface filling
- An extraction
- Treatment provided by the hygienist.
For items that vary in cost, the price list can use a ‘from’ and to’ price range to explain their prices.
Inform the patient, as soon as possible, if the cost of their treatment changes
Sometimes, circumstances may change and there may be alterations to the treatment plan. Make sure you warn the patient beforehand if you believe that further treatment is necessary and inform them of the additional costs that will be involved. Revisions to the treatment plan need to be flagged to the patient, who must give their consent, following which an amended written treatment plan and cost estimate must be issued.
Do not pressurise patients to accept private treatment
While you can give NHS patients the option of undergoing their treatment privately, you should not put pressure on the patient to accept private treatment. You should have an open discussion with the patient and be prepared to answer any questions the patient has about costs.
For example, it is not acceptable for a dentist to tell an NHS patient that they cannot carry out treatment available on the NHS such as root canal treatment, but then offer do so on a private basis. The quality of NHS treatment should not be used as a way to encourage patients to pay for private care.
Be cautious about offering vouchers or discount treatments
Taking part in discount schemes for treatments can be interpreted as committing yourself to providing treatment that may not prove clinically necessary, appropriate or in the patient’s best interest on examination.
Complaints could arise from a patient paying and expecting treatment that is not in their best interest.
Do not rush patients into treatment
When it comes to dental treatments, snap decision-making is likely to be counter-productive and ineffective. Instead it is frequently advantageous to offer patients a ‘cooling off’ period, particularly before expensive or extensive procedures begin, so patients have the opportunity to reconsider and weigh up the pros and cons of the proposed treatment.
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