Case study – recovery of outstanding fees and lessons learned

A dentist provided treatment to a patient in the form of extensive fixed porcelain bridge work. The patient paid interim invoices rendered during the course of the treatment. The patient failed to pay the final invoice of $5,200 expressing that she believed that she had already paid for the cost of the treatment.

The patient alleges that she attempted to contact the dentist but was told that he was not prepared to see her for a review appointment until the outstanding invoice was paid. The dentist maintained that the cost of treatment was set out in verbal quotations provided, and which had been revised following changes to the plan for treatment.

After some time, the dentist issued proceedings against the patient seeking to recover the unpaid fee.

The patient filed a Defence denying that her informed consent for the treatment and its cost was obtained. The patient made a counter-claim alleging poor quality workmanship. In particular, the patient alleged that the agreement was entirely oral, that the porcelain bridge was a poor colour match for her lower teeth and that there were inadequacies in the size, positioning, form and texture of the bridge. The patient sought damages to rectify the alleged sub-standard bridge work and for personal injury, in the amount of $30,000.

The dentist denied the allegations of poor workmanship.

Of note is the fact that the patient and dentist had a good relationship prior to the dispute over fees. The dentist maintains that the patient had not expressed any concern with the appearance of the bridge following its insertion. Certainly, the patient’s initial written complaint to the dentist did not express dissatisfaction with the treatment, but merely confusion in relation to the amount outstanding.

The dentist is now in the unfortunate position of having to defend a professional negligence claim in relation to his treatment and the possibility of a damages award against him, well in excess of the amount he sought to recover. There is also the potential for a complaint to the Disciplinary Board.

What can we learn from this case?

It is inevitable that dentists will have to deal with the circumstance of a patient refusing to pay fees for treatment rendered. We recommend that before issuing proceedings to recover outstanding debts or placing outstanding accounts in the hands of debt recovery agents, that practitioners first make direct contact with the patient.

If a dispute in relation to fees arises, it is important that before issuing proceedings, the practitioner first ascertains from the patient the basis for their objection and specifically, whether it arises from any concern about the standard of treatment performed.

If the patient does cite dissatisfaction with the treatment, then we suggest that a practitioner arrange to meet with the patient for a review appointment to try and work through the patient’s concerns.

If the matter cannot be sorted out directly with the patient, a practitioner could give consideration to sending the patient for a second opinion regarding the adequacy of the treatment. That way, if concerns are well founded, attempts can be made to resolve the claim taking into account the fees outstanding and without resort to the stress of litigation.

It is important that practitioners ensure that each patient is provided with a written costs agreement at the outset of the treatment, and that this agreement clearly outlines the plan for treatment as well as the estimated cost of the treatment. That way, if a dispute arises, the patient can be referred back to the agreement which forms part of the contractual arrangement. It is recommended that practitioners insist on patients signing the agreement as evidence of their consent and as evidence of their acknowledgement of the terms of payment that are set out in the agreement.

If further treatment that was not initially anticipated is required, it is recommended that the patient is provided with a written, revised agreement and that practitioners obtain the patient’s further written consent to the treatment prior to undertaking any additional work.

If instalment payments are contemplated, it is recommended that the costs agreement clearly sets out the amount of each and every instalment and the trigger for payment (eg. following the insertion of fixed appliances). The agreement should set out the terms of payment (eg. payment within 14 days). The agreement should set out the consequences if payment is not made within the time allowed (eg. whether interest is proposed to be charged and, if so, at what rate and on what amount).

It is evitable that some complaints cannot be resolved despite the best efforts of the dentist concerned however, by ensuring the terms of the arrangement with the patient is in writing and is clear, practitioners will be better placed to resolve any fee dispute that may arise.

 

Kellie Dell’Oro
Principal, Meridian Lawyers

Sarah McPherson
Solicitor, Meridian Lawyers


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