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Ensuring patients understand and agree to the cost of treatment… It’s all about good and early communication

Originally published in the February/March 2015 issue of Dispatch

Dentists have a legal and ethical obligation to obtain their patients’ informed consent prior to the start of treatment. Discussions about dental services also need to include information about the costs involved and the patient’s responsibilities regarding payment. It is prudent to advise patients if you intend to charge fees that are above the fees listed in the Ontario Dental Association’s Suggested Fee Guide.

Any estimates provided to a patient should include the cost of additional expense of materials (at cost) and laboratory fees (at cost), when applicable, and any additional treatment; for example, a crown following endodontic therapy or a retentive appliance following active orthodontic treatment. When in doubt about the exact costs that may be involved, provide an estimate that includes a range of low and high costs, so that the patient will not be presented with an invoice that exceeds the higher amount of the estimate.

For complex cases, dentists may consider discussing the costs of subsequent treatment that could be required due to unforeseen circumstances, such as the failure of an implant to Osseo integrate.

Allow patients ample opportunity to ask questions so that they fully understand the proposed treatment and its associated costs. Likewise, give patients time to carefully consider the treatment options, particularly if the proposed treatment is costly. A separate appointment may need to be booked to discuss the financial aspects of a complex treatment plan.

Once the dentist has obtained the patient’s informed consent to treatment, the fees and the financial arrangements can be reviewed with the patient by office staff; however, dentists bear the ultimate responsibility for obtaining informed consent.

A dentist should only proceed with treatment once informed consent has been obtained. If a dentist determines that an alteration to the treatment plan is necessary during treatment, while the patient is in the chair, the dentist should ensure that the additional costs are explained (among other things), and confirm that the patient, parent or substitute decision maker agrees, prior to proceeding.Although a discussion with patients about financial issues can be uncomfortable, being clear, open and upfront about the actual costs that are involved with any treatment plan will help avoid misunderstandings and a potential deterioration of the dentist-patient relationship. Open communication about fees may also reduce the likelihood of an eventual complaint to the College.

Insured patients

If a patient with dental coverage requests a predetermination, the dental office may prepare it for them. This provides an opportunity to remind patients of their responsibility regarding payment of costs or services not covered by their insurance plans. Dentists must make reasonable attempts to collect deductibles and co-payments unless they have received the third-party payer’s permission in writing that these out-of-pocket costs can be waived.

Fees and minors

It is important to remember that, although a minor may be able to consent on his or her own behalf to treatment, a payment arrangement entered into with a minor may not be enforceable. A patient’s parent(s) or guardian(s) may, of course, enter into a binding contract with the dentist for the fees associated with the minor’s dental care.

If the minor patient is 16 years of age or older, dentists should first obtain the patient’s consent to discuss their dental situation before discussing it with the parent, guardian or any other individual responsible for payment.

Financial agreements

When complicated treatment plans are involved, dentists should consider creating a detailed written financial agreement before treatment starts. In this agreement, the total fee, lab fee, and the payment schedule should be made clear to the patient. Also, the agreement must address such issues as unforeseen complications, failed appointments, discontinuation of treatment by the patient and any refunds that would result, as well as fees for additional consultation time the patient requests that was not part of the dentist’s estimate. The dentist should try to anticipate potential areas of difficulty and establish a policy to deal with them.