When should you refund a dissatisfied patient?

When should you refund a dissatisfied patient?

Issuing refunds to patients is not out of the ordinary for dental practices. To protect your livelihood, you will want to follow some prescribed guidelines, reducing the chances of an unhappy customer filing a malpractice claim.

By Ty M. Galvin, D.D.S., and Michael A. Gile, D.D.S

Dentists understand they must issue refunds to unhappy patients from time to time. It’s not an unusual circumstance nor should it be disruptive to your practice. Maybe you performed a basic service that ultimately wasn’t covered by the patient’s insurance, or a structural issue arose with a crown or bridge that you feel responsible for.

In these cases, there are ways to reduce your liability and still defuse the situation when offering out-of-pocket dollars back to the patient.

5 steps to processing a refund

In your practice, you’ve come to know many patients — some better than others. If a refund request occurs, you might be tempted to write a check and quickly put the incident behind you. But this could pose a problem regardless of how well you know the patient. So, it’s prudent to establish and consistently abide by a formal process for refunds. Here’s how.

1.     Determine the reason for the refund.

Before issuing a refund, investigate the reason for the patient request and determine the validity of the patient claim. That starts with a basic fact find. A patient’s concerns will usually be conveyed via an initial phone call or email to your office. Make it a point to have your staff gather as much information as possible about the issue when this occurs.

You’ll then need to review the facts before deciding to provide a refund. It may be a snap decision to refund $40 for a fluoride treatment that’s not covered by insurance, but refunding the full cost of an implant will warrant a more thorough review. 

 2.     Search for an alternate resolution to the issue.

Money may not be the only remedy to a patient’s dissatisfaction. If the issue pertains to reconstructive dental work you performed, addressing and fixing the perceived issue with a tooth, bridge or crown might alleviate the concern. When the patient recognizes that you’re taking every conceivable step to correct the problem, your goodwill could be enough to make everything right.

Your ultimate goal is to make the patient happy, but in some cases that objective may be unrealistic. Some individuals may persist with their claim to a refund despite your best efforts to placate them.

3.     Document every step of the process.

It’s critical to gather all pertinent information surrounding the frustrated patient’s experience. Document each communication between the patient and your office, noting the date, time and specific details of conversations and emails. Make sure to log all work performed or discussed in the patient’s chart.

Make note of the patient’s demeanor during face-to-face meetings or phone calls as well and use neutral language when interpreting or documenting their behavior. Observing hostile or irrational behavior may not cloud the facts of an issue but documenting state of mind could have some bearing on outcomes — if the dispute finds its way into the legal system.

4.     Incorporate a formal release document into the refund process.

If the patient agrees to a settlement, refunding or waiving a payment is only one part of the deal. Formalizing the terms in writing could help deter any further action taken on the patient’s behalf. In some instances, you may simply be forgiving a balance due but before writing a check, obtain a signed release, which could help permanently close the case, or provide the necessary documentation should it proceed to a claim, lawsuit, or State Board action.

The release form is a document the patient signs to lessen the risk of litigation or a board complaint. A signed release should be secured before you refund a patient. Asking for a signature on a release could trigger an unpleasant reaction from an aggrieved patient. Faced with that possibility, you might look for another way to diffuse the situation.

Note that the general release form should be recreated on your office’s letterhead. If you mail the release to the patient to sign, include a self-addressed envelope to make the process easier for them, along with a letter that notes the following information:

  • The refund won’t be processed without a signature on the release
  • A mention that a payment removes your office from any future liability
  • A time frame within which the release must be signed and returned

You don’t need to self-report a simple refund to the National Practitioner Data Bank, but payments from state law actions or lawsuits must be.

5.     Stay mindful of potential malpractice claims.

Malpractice claims are an unlikely result of a refund request, but the possibility can’t be entirely dismissed. A simple refund process won’t require you to contact your insurance broker or carrier, but escalation beyond an open and shut case will mandate a notification.

Two occurrences indicate that the patient may be pursuing legal action: If you receive notice from an attorney representing the patient, and/or the patient turns the matter over to the state dental board. If faced with either of these consequences, inform your broker or carrier immediately.

It goes with the territory

Unhappy patients are just part of the landscape of having a dental practice, and sometimes you simply have to sever ties with them. Consider these mildly unpleasant circumstances a cost of doing business. You can hope that refund requests get resolved quickly and simply but be wary of how dissatisfaction might turn into something more complex and costly.

For more information on how to protect yourself from unwanted claims, contact PPP Risk Management.

This information is intended for informational purposes only. Professional Protector Plan for Dentists is not liable for any loss or damage arising out of or in connection with the use of this information.

Considering dismissing a difficult patient? Here’s when and how dentists can do it

Considering dismissing a difficult patient? Here’s when and how dentists can do it

Dentists have the right to dismiss unruly patients, but when done without due diligence, practitioners are vulnerable to wrongful abandonment and discrimination lawsuits. Know when and how to end a provider-patient relationship.

By Ty M. Galvin, D.D.S. and Michael A. Gile, D.D.S.

Are you obligated to continue treating a patient who repeatedly misses appointments, argues over treatment, disputes financial agreements or is increasingly rude to your staff?

While “patient divorce” may carry a stigma, the well-being of the doctor, staff and patient are worth the uncomfortable dismissal process. It is within a dentist’s full right to dismiss a patient if the dismissal is not for a legally impermissible discriminatory reason.[1]

As health professionals, we believe in our duty of care to our patients. This can make the decision to dismiss one particularly challenging but is a key component of doing our jobs well and providing optimal care to all.

When is it appropriate to dismiss a patient?

First and foremost, you cannot dismiss a patient based on their race, gender, national origin, disability, religion, genetic information or age. Practitioners are responsible for accommodating disabilities, such as providing interpreters for individuals who are hard of hearing during their treatment, for example.

It is a person’s behavior toward you and those within your office which will drive a decision to separate. Here are three key reasons to dismiss a patient:

  1. They are abusive to others within your office. Your first responsibility as a dentist and employer is to your patients and staff. When another patient becomes verbally or physically abusive, or sexually inappropriate to your team or toward fellow patients, they are a liability to your practice.

Case in point: When a young patient’s crown fell off days after treatment, instead of calmly requesting a replacement, one mother berated the dentist’s staff and threatened to ruin the office’s reputation. After a new crown was cemented, completing the treatment, the child and mother were dismissed from the practice due to harassment, libel and extortion of the office staff.

  1. They continuously miss appointments or refuse the recommended treatment. Refusal can take a variety of forms, from not scheduling follow up appointments to dictating the type of materials you use. Before you dismiss these patients, you can inquire about concerns or fears that may be causing them to ghost or implement policies like charging for no-shows.

Case in point: A new patient comes in for a replacement of four crowns. The patient refuses the dentist’s standard process and recommendations, insists on the use of a different lab and porcelain fused to metal crowns instead of zirconium. If the procedures have not been started, the patient can be dismissed on account of dictating treatment other than what the dentist recommends.

  1. They refuse to pay for performed treatments. A common cause for dismissal is nonpayment. In these instances, it is important to distinguish between patients who cannot pay and will not pay. Providing payment plans is one way to accommodate those who need assistance, but a refusal to make these payments is also reason for dismissal.

Case in point: A patient commits to a quadrant of dentistry including two crowns and a filling.  The patient agrees to financial arrangements but refuses to pay after the treatment is completed and tells the office staff “The work is already done, what are you going to do about it?”

Real concern happens when a difficult patient’s non-compliant behavior escalates. Paying attention and noting incidents can help track behavior and indicate the need for dismissal. Comprehensive chart documentation can support your decision should it lead to a claim.

The dos and don’ts of dismissing a patient

A successful “patient divorce” occurs when the patient does not leave the relationship angry and litigious. Here are best practices for ending the relationship quickly and without further incident.


  • Have the right documentation. If a patient should ever dispute their dismissal, you’ll need objective documentation of all incidents to substantiate your decision. This includes any emails, voicemails or texts from the patient as well as records of any outreach to them concerning their behavior. Keep these in their chart so they can be easily sourced.
  • Consult your State Board guidelines. States may have specific requirements around dismissing patients including how many days you must provide emergency care after dismissal.
  • Send a discharge notification letter by regular and certified mail. This maintains a one-way communication, void of dispute. Phone calls and emails are not recommended as they encourage potentially argumentative discussions. It is also best practice to include notes within this communication detailing additional care you recommend for the patient, as to avoid any accusations of abandonment.
  • Continue care for 30 days from the date of the notification letter. Remember, check your state for additional requirements.
  • Be courteous but concise. Practitioners are not required to provide a specific reason for service termination. Instead, recommend resources for finding a new dental office and explain how you will transfer medical records when appropriate.


  • Admit to not meeting the patient’s needs. It’s instinctual to apologize when you’re in uncomfortable situations or to avoid conflict. However, you don’t want to confuse the situation with malpractice.
  • Recommend another dentist. It’s better not to be blamed for another unsuccessful doctor-patient relationship. Keep your recommendations to resources such as the patient’s friends, family, social media and the internet to guide their search.
  • End a relationship in the middle of a treatment phase. The patient’s wellbeing takes priority. Make sure to time the discharge as to not endanger the patient’s oral health.

We all have those patients on the schedule that cause stress for the doctor and staff. While ending a relationship is never easy, dismissing a challenging patient can not only be a relief for the entire team, but it also likely puts the patient in a situation where they can receive better care.

When you follow the recommendations on when and how to end a relationship with a difficult patient, you’re building an environment more conducive to helping your other patients and keeping you and your staff safe. 

For more information on protecting your practice in difficult situations, contact PPP Risk Management.

This information is intended for informational purposes only. Professional Protector Plan for Dentists is not liable for any loss or damage arising out of or in connection with the use of this information.

[1] American Dental Association “Patient dismissal: Guidelines for Practice Success | Managing Patients | Patient Relations,” 2023.