Imagine taking your car to the shop for a minor repair — say, to replace the spark plugs or patch a tire. Now, imagine picking your car up at the end of the day to discover that your engine has been completely rebuilt — and you’re responsible for the bill.
This scenario would be unlikely to occur in the auto repair industry, but it happens all too often in the dental industry, leaving broken trust, unhappy patients and disputed bills in its wake.
In one case reported to The Dentists Insurance Company, a patient was diagnosed with needing a three-surface filling. Although the patient was not experiencing any pain, decay was visible on the radiograph. The dentist explained to the patient that there was a possibility a three-surface filling would not suffice, and instead a crown may be needed, which would be a more involved procedure. The patient scheduled an appointment for the filling.
During treatment, the dentist discovered that the tooth required more support and a crown would be a better option. The dentist told the patient that the treatment would take a bit longer and proceeded with preparing the tooth for a crown and provisionalizing it. He advised the patient to return in a few weeks for the permanent crown. Upon scheduling his next appointment, the patient was presented with a bill that was three times the original estimate. Staff explained the reason for the price difference and although the patient was upset about the increased treatment cost, he reluctantly paid with a credit card.
The patient failed the appointment to seat the permanent crown. Instead, he disputed the charge with his credit card company, which initiated a chargeback to the dentist’s merchant account. The credit card company asked for documentation to support the charges. The office could only provide documentation of the patient’s acceptance of the fee for the three-surface filling, as a new treatment plan was never presented or signed by the patient when the treatment changed.
Trina Cervantes, Risk Management analyst with TDIC, said the issue stemmed from the dentist’s failure to disclose the cost involved with the crown prior to preparing it. While he went over the cost of the filling, and mentioned the possibility the tooth may need a crown, he did not inform the patient that should he need a crown, it would be significantly more expensive.
“The patient felt ambushed,” Cervantes said. “Had he known earlier, he could have saved up the money, waited until he was in a better financial situation or set up a payment plan. Rather, he felt he was taken advantage of and questioned the need for the crown at all since it was not causing him pain.”
Unfortunately, this is a common scenario. Far too often, dentists either fail to provide a thorough treatment plan or they fail to update the plan once the recommended treatment changes. The reasons for this are varied. Some dentists are so focused on clinical care that they do not consider the financial impact for the patient. Others assume that patients are as versed in the cost of dental treatment as they are; to a dentist, it makes sense that a crown would cost more, but the difference is not so obvious to a layperson.
“What is clear to a dentist is not necessarily clear to a patient,” Cervantes said. “If it is not outlined in a treatment plan, patients may not understand what their financial obligations are.”
Cervantes says communication is key to avoiding misunderstanding. Providing detailed treatment plans, outlining all options and the costs associated with them, can help mitigate any potential risk. Dentists can easily get caught up in the moment when the patient is in the chair. But even when the treatment plan changes course mid-treatment, a revised treatment plan should be printed and signed by the patient before proceeding.
“Clear communication is critical to transparent practices, especially when money is involved,” Cervantes said. “It is important that dentists and staff get in the habit of confirming that the treatment plan is reviewed and accepted by the patient prior to performing the work.”
TDIC recommends keeping a signed copy of the treatment plan on file. In fact, Cervantes says having a signed treatment plan and consent form is the first line of defense should a lawsuit arise.
“It is up to the dentist to outline the risks associated with not following through with proposed treatment,” she said. “You can’t make the patient get the work done, but you can show evidence of reviewing these risks and trying to get the patient back in the office to complete treatment.”
Another consequence of poor doctor-patient communication is a breakdown of trust. Patients can begin to question whether the treatment was needed, or whether the dentist was simply trying to make a quick and easy buck. In some cases, unhappy patients have filed complaints with the dental board, placing a practice under unwanted scrutiny and causing avoidable headaches. In other cases, patients have turned to social media to voice their dissatisfaction through negative comments.
Providing patients with detailed treatment plans with cost breakdowns is essential for any practice owner. Communication and transparency allow patients to make informed decisions about their oral health, meet patient expectations and minimize patient complaints.