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.