Handling Requests for Refunds in the Dental Practice Setting

Patient requests for a service refund may be driven by many factors, including dissatisfaction with care, changes in financial circumstances, second thoughts about services (buyer’s regret), treatment complications, and—unfortunately—unprofessional communication from downstream practitioners.

Managing a patient’s request for a refund requires caution and a measured response. Refund requests are not only one of the most common patient concerns, but they are also one of the most complex because dental plans, state laws, and boards of dentistry may involve different rules and guidelines.

Investigate the Request

Investigate patient requests for a refund as you would any other type of patient concern or adverse event. To help you evaluate the situation, review the patient’s dental records and talk with the practice manager, biller, and clinical staff.

You may need to contact the patient for additional information. Remain objective as you ask questions—which may include, “Are you willing to come in for an examination and discuss options?” and “If you decide to see another dentist, will you obtain and share the records with me?”

Once you have gathered all of the relevant details, contact your patient safety risk manager for guidance.

Formal Demands for Compensation

If you receive a formal written or legal demand for compensation or if the patient is angry, belligerent, or threatening, notify The Doctors Company as soon as practical. Your patient safety risk manager can advise you on investigating the event, communicating effectively, and dismissing the patient from your practice if necessary. The patient’s demand for compensation will be handled through the Claims Department.

Our claims professionals are equipped to guide you through the process and ensure that your interests are protected. Reporting events to The Doctors Company in a timely manner does not negatively affect your premium. In fact, your policy calls for timely reporting—and early reporting is shown to have a positive impact on outcomes.

Patient Communication Strategies

When a patient asks for a refund, remain calm and avoid becoming defensive. Avoid the urge to offer to “pay for everything” or to defend the care before learning all the facts or the patient’s concerns. The request may signal an opportunity to improve patient relations or care.

For requests made by telephone or in person, consider using a service recovery strategy such as BLAST:¹

• Believe the patient until or unless there is a reason not to.

• Listen to the whole story—do not interrupt. Ask clarifying questions. Understanding what the patient thinks is wrong and the outcome the patient was hoping for is critical. If the patient has seen another dentist or specialist, ask for a copy of the records and provide the patient with an authorization to release protected health information form.

• Acknowledge the conversation by summarizing what the patient has told you and apologizing for any discomfort or inconvenience as appropriate. It is important to conduct a full investigation of what happened before further action.

• Satisfying the patient or coming to a resolution during the first communication may not be possible. Instead, advise the patient that you need time to consider the information, speak with the staff, review the records, and complete research. Determine how the patient would like to receive follow-up and agree on a time and method for the subsequent communication.

• Thank the patient for sharing concerns.

Preventive Strategies

Consider the following prevention strategies:

• Use a formal process for accepting new patients. Incorporate patient expectations into new patient material and on your website. Consider using a Conditions of Treatment Agreement during the onboarding process to help proactively create and maintain a positive practice-patient relationship. See our article “Proactively Manage Patient Expectations With a Conditions of Treatment Agreement” for more information.
• Apply patient selection criteria to ensure the patient is an appropriate candidate for the proposed treatment.
• Develop and execute thorough informed consent and refusal processes. Meticulously document the discussions with the patient. For more information, see our resources about “Informed Consent/Shared Decision Making.”
• Educate all practitioners and staff on communicating with dissatisfied patients. For more information, see our guide Effective Patient Communication: Strategies for Challenging Situations.

Practice Quick Check

Does your practice have a formal process in place to manage refund requests that includes the following:

• Early consultation with The Doctors Company or an attorney.
• Objective consideration of the accuracy/likelihood of the criticisms of care.
• Collaboration/negotiation with the patient or decision-maker.
• Adhering to insurance company or third-party payer requirements for refunding payment.
• Using a waiver/release as appropriate as a prior condition of refund.
• Determining whether the patient will remain in the practice.

For our complete checklist tool on addressing dissatisfied patients, see Quick Check: Dissatisfied Patient Management. For assistance in addressing any patient safety or risk management concerns, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email.