Money problems

Strategies for keeping the patient comfortable when presenting the bill.

They say that money is the root of all evil and that it influences some of the more significant problems in our private lives.

In practice, however, money problems can be far more fundamental. A few bad debts will exist in most practices; very few have none at all. As the recession begins to hit deeper, not all our patients will be quite as prepared to pay their bills as promptly as we would expect them to do.

Here are ten key tips to help avoid problems for the dentist and patient alike as they deal with the present economic situation and the reality of paying dental fees.

1. It is often best to talk about money upfront and at the earliest possible opportunity. As part of the normal consent process, most clinicians will discuss the pros and cons of each treatment option and will outline which they feel is in the patient's best interest. It is also the ideal time to talk about cost, even if it is only a 'ballpark' figure for each element of treatment. If the figure is likely to change tell the patient about the possibility and agree to keep them informed.
2. Many practices employ treatment coordinators to help explain treatment options. Such coordinators are usually an experienced member of the dental nursing or receptionist team who understands what is involved in the treatment and can therefore answer the majority of patient's questions. This is an ideal time to approach the subject of fees, as patients will almost certainly use such information when reaching a decision about the treatment options that have been provided.
   Understanding the differences in the relative cost of various options is an important part of patient choice.
3. The use of written treatment plans and estimates should be regarded as essential for larger and more complicated treatment plans. These can be in the form of a pro-forma or included as part of a letter. In addition, you should make sure the contents of the estimate are written in plain English, so that the patient has no difficulty in understanding the details.
4. Make sure the patient knows their own obligations in relation to the payment of fees, particularly if payment is to be spread over a period of time. In this respect the use of monthly or weekly payments by standing order has proved extremely helpful to practices and patients alike as it allows the cost of treatment to be spread over the treatment period. There are several finance schemes that provide this service specifically for dental patients.
5. Asking patients to pay for their treatment on the day the treatment occurs is not unprofessional and allows a degree of transparency from the patient's perspective - it is the way they pay for many other services in their life. By contrast asking patients to pay at the end of the treatment or sending out monthly accounts after the treatment has completed may be regarded as traditional but carries far greater risks in today's economic climate.
6. Discount programmes and other 'special offers' may be regarded by the GDC, as a financial inducement to treatment and therefore should only be used where you are sure that no such criticism can be made - if you are in any doubt please seek the advice of Dental Protection before the scheme is put in place.
7. If a bad debt is incurred, then do your best to try and collect those fees politely and appropriately. Telephoning a patient to ask for the debt is appropriate provided that you are sure that the person on the telephone is the patient. Unless you take care to verify the identity of the person you are speaking to it is very easy to find that you are breaching confidentiality of the patient who actually received the treatment.
8. Some practices have found that offering to take payments over the telephone using a credit or debit card can be an extremely helpful way of collecting an outstanding fee, particularly for the more 'forgetful' patients. The administration costs for collecting money in this way can be passed on to the patient, provided that the patient is fully aware of this additional charge and agrees. Many practices waive this charge and argue that it is a small price to pay when compared to collecting a bad debt.
9. The use of a debt collection agency should be the last resort, rather than the first and should only be considered when all other avenues are exhausted.
   The patient should always be warned in writing that such action will occur if the debt remains unpaid. Please be aware that once the debt collection agency is instructed you do not have any control over the correspondence between yourself and the patient and this can lead to difficulties, particularly if the content of the letter are seen as threatening or inappropriate.
10. You should pause for thought before taking a patient to court to obtain payment of an outstanding bill. The usual defence to such action is for the patient to issue a counter claim alleging negligence, even if only as a means to buy some time.
    Consequently, you should think carefully about whether the patient might have any basis for such a counter-claim. Look carefully at your records and if in doubt, seek advice from Dental Protection. Even if you are successful in defending such a counter-claim there is no guarantee that the patient will actually pay the outstanding debt. In such a situation arises then further court action will be required and obtaining a judgment is very different to obtaining payment. The true cost (in respect of the time and aggravation to the dentist) can often be far more than the original claim was ever worth.

Mike Clarke is a senior dentolegal adviser with Dental Protection based in Leeds.