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  • FIRST POST
    • naomiamy
    • By naomiamy 11th Oct 16, 8:36 PM
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    naomiamy
    NHS Dental Charges
    • #1
    • 11th Oct 16, 8:36 PM
    NHS Dental Charges 11th Oct 16 at 8:36 PM
    I think I've been overcharged by my dentist...?
    I have NHS dental treatments, and on July 4th this year was told I would need 4 fillings. I was given the option of paying the band 1 payment then after treatment paying the reminder to make it band 2, or to simply pay the band 2 payment upfront - I took this option to get it out the way. I then booked the treatment appointments - the dentist suggested 2 appointments to get 2 fillings each time. I booked one for July 21 and one for August 11, which the receptionist wrote on a card for me. First appointment went fine, but I had a voicemail in August reminding me about an appointment on August 9 - due to the date on my card being August 11 I had planned for this and was unable to make the appointment on the 9th so called up to cancel, explaining that she had put the wrong date on my card. She said to call back after speaking to work and consulting my diary to get it rescheduled, and I went in for my second 2 fillings on Monday 10 October (yesterday). After my fillings were done the dentist told me there had been 2 months between appointments so I'd have to pay the band 2 payment again. I was told I had no option but to pay it and that he would call the NHS for me to see about getting me a refund. When I went to the receptionist to pay and book for my next checkup she charged me but said they wouldn't be contacting the NHS, and I was welcome to try for a refund but it was unlikely. Unfortunately I'd waited so long for my appointment I was really late for work so couldn't stand and argue my case. I feel that because the fillings were all decided on from my first appointment as one course of treatment then this should all be just one payment at band 2, not 2 payments. Nothing was mentioned over the phone that I'd have to pay extra due to a gap between appointments, especially since I had to cancel due to their error of mixing up my dates. The receptionist says it's not her place to refund me when I called today. Am I right here? Should I be getting a refund for the second payment?
Page 1
    • brook2jack
    • By brook2jack 11th Oct 16, 8:50 PM
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    brook2jack
    • #2
    • 11th Oct 16, 8:50 PM
    • #2
    • 11th Oct 16, 8:50 PM
    Unfortunately the dentist has a contractual commitment to finish treatment within a two month period. If they send the forms off late they will not get paid and indeed the money already paid by the patient is taken off the whole contract value. This is particularly important where people cancel or miss appointments and do not make a new appointment within two months of their last appointment.

    The practical implication is that most dental practices have signs up warning that if you cancel or miss appointments and there is a two month or more gap , a new course of treatment has to be opened with new charges.

    The dental surgery has no discretion to wave these charges as two courses of treatment have been opened and you cannot continue a course of treatment if more than two months have elapsed and the NHS will not refund the charges.
    • naomiamy
    • By naomiamy 11th Oct 16, 8:57 PM
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    naomiamy
    • #3
    • 11th Oct 16, 8:57 PM
    • #3
    • 11th Oct 16, 8:57 PM
    Really? Their poster makes no mention of 2 months, and since it was their error with my appointment card and I made the next available appointment, surely it's their problem they couldn't fit me in in 2 months? Or they could at least have mentioned it over the phone?
    • brook2jack
    • By brook2jack 11th Oct 16, 9:12 PM
    • 3,956 Posts
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    brook2jack
    • #4
    • 11th Oct 16, 9:12 PM
    • #4
    • 11th Oct 16, 9:12 PM
    Yes they should have mentioned it on the phone but the NHS business service is very strict on the timing of sending forms off.

    If the practice was unable to offer you any appointment for a couple of months then you may have had a case to for them to try to keep a course of treatment open .But if there were appointments but just not at a time to suit you then they have to send the form off.

    To put this into context the NHS will not refund you the charge. If the practice refunds you the charge it comes out of their pocket so effectively it will have cost them to provide your fillings and check up.

    Here is a copy of an NHS dentists conditions with mention of the two month rule.

    http://www.bath.ac.uk/dentist/appointments.html

    And another http://www.rudgwickdental.co.uk/Appointments.html
    Last edited by brook2jack; 11-10-2016 at 9:17 PM.
    • marian66
    • By marian66 27th Jan 17, 7:26 PM
    • 1 Posts
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    marian66
    • #5
    • 27th Jan 17, 7:26 PM
    Am I being ripped off ?
    • #5
    • 27th Jan 17, 7:26 PM
    I rarely go to a Dentist as I have had a bad experience when young which has left my so anxious when I need to.
    I had a very painful infection on the top right side of my face . i got an emergency app on the 28/12/16.the dentist looked onto my mouth informed me yes i had an infection and she wound prescribe me antibiotics .( which she did ) And to make a return appointment to see what to do next . I got charged £ 19:70 on this day. I returned again on the 04/01/17 X-rays were taken from where I had the infection. the dentist informed me I would have to have an extraction .( I am petrified of this ) I agreed to have it done on this day , to get it over and done with I also asked the dentist about another tooth I had which was broken , this was also X-rayed. I also asked for a mouth guard as i grind continuous in my sleep.I never got a reply about the mouth guard but I was so anxious about the extraction I did not ask again I had injections (2) in the area surrounding the tooth that was infected ,after the extraction she gave me advice as to what to do next ( regarding the healing of my gum area) .My bill was £233.70 I made another app for the fillings on my other tooth.27/01/17. I had very painful gums and toothache after the extraction for days on the 09/01/17 I rang the dentist up and make an app to see why this was. the dentist informed me I has dry socket and I got a dressing for this , while there I informed the dentist I had new toothache pains , she took more X-rays and advised me I need more extractions because where I had the new toothache was decayed and there was nothing she could do to save it . I also has an impression done for my tooth guard on this day . I was asked if I wanted the filling done on this day but i declined as I said I needed time to prepare knowing it was happening. ( not so brave the second time ) .
    I attended the app on the 27/01/17 ready for the fillings but the dentist told me " you do know this is for a short period only , because this tooth needs extracting also I was shocked to hear this as I was told has previously just needed fillings . My dentist does know how petrified I am regarding anyone near my mouth . and hearing this really scared me I asked what was the best way I could have it done . She said " Our man ( the owner of the clinic ) can do sedation , he will be able to extract both teeth and it will be less stressful for you . I jumped at this and said yes.I did say to her I also will have less teeth to chew with and asked what will I do if I have nothing to eat with she advised me I can have denture,s but personally I would not be happy with dentures . I asked about a bridge she again informed me I would have to wait 3 months to have a bridge x2 after extractions , and I would have to pay another "233.70 . while she was doing the necessary forms I asked . " this is included in the £233.70 from before ? she said" No this is private £90 for sedation and £120 for the extraction " I thought Oh Ok and waited . I got my mouth guard on this app and also made a date for the next extraction .
    I came away from the dentist feeling lost and anxious , while feeling 2 why am I paying so much on a NHS Dentist surgery . Please can anyone advised .
    Thank you in advance .
    • McKneff
    • By McKneff 27th Jan 17, 8:33 PM
    • 35,347 Posts
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    McKneff
    • #6
    • 27th Jan 17, 8:33 PM
    • #6
    • 27th Jan 17, 8:33 PM
    You should start a thread of your own . It's considered bad manners to hijack some one else's. And it ends up confusing cos no one knows who is talking to who
    No one can make you feel inferior without your consent
    • welshdent
    • By welshdent 27th Jan 17, 8:46 PM
    • 1,828 Posts
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    welshdent
    • #7
    • 27th Jan 17, 8:46 PM
    • #7
    • 27th Jan 17, 8:46 PM
    On the topic of private sedation and private extraction. That's unfortunately correct. If a practice does not have an NHS contract to provide sedation they are explicitly prevented from providing NHS treatment if they do private sedation.

    You can't have a bridge for a few months following an extraction because the bone needs time to heal. That would then necessitate a new course of treatment and thus additional fees.

    To be honest. You may not like this but if you have not been to a dentist for a while and have a lot of dental disease - gum disease, decay etc. It is unrealistic to expect all work to be totally completed on one course of treatment and one fee if you want more than just a clean and extractions. You need time for bone to heal, gum to stabilise, new habits for cleaning and diet to take effect. Dentistry is not like medicine. The dentist foots the bill and is remunerated according to agreed bands. They don't set them. They have no control over them. They also have no control over how you heal or how you look after yourself after. Trying to correct problems that took years to develop in a couple of appointments is imho unrealistic
    • justme111
    • By justme111 27th Jan 17, 10:34 PM
    • 2,622 Posts
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    justme111
    • #8
    • 27th Jan 17, 10:34 PM
    • #8
    • 27th Jan 17, 10:34 PM
    It would be like going to doctors and expect to get rid of diabetes and high blood pressure. They can only try to minimise the damage caused by these conditions, not produce a new you without a trace of them
    • Firtree85
    • By Firtree85 3rd Feb 17, 12:05 AM
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    Firtree85
    • #9
    • 3rd Feb 17, 12:05 AM
    • #9
    • 3rd Feb 17, 12:05 AM
    Unfortunately the dentist has a contractual commitment to finish treatment within a two month period. If they send the forms off late they will not get paid and indeed the money already paid by the patient is taken off the whole contract value. This is particularly important where people cancel or miss appointments and do not make a new appointment within two months of their last appointment.

    The practical implication is that most dental practices have signs up warning that if you cancel or miss appointments and there is a two month or more gap , a new course of treatment has to be opened with new charges.

    The dental surgery has no discretion to wave these charges as two courses of treatment have been opened and you cannot continue a course of treatment if more than two months have elapsed and the NHS will not refund the charges.
    Originally posted by brook2jack
    Technically this is not true.

    The NHS advises that courses of treatment be completed within a "reasonable" time frame but do not specify the exact length of time that a COT can be kept open for.
    If a COT is to be abandoned, without all items of planned treatment being completed, and the patient marked as failed to return on the BSA submission, then reasonable effort must have been made to contact the patient and arrange an appointment. This usually involves two methods of contact, one of which must advise the patient that if they fail to return for treatment they will be liable for a second banded treatment cost.

    The '2 month rule' you are referring to actually relates to the time frame in which a COMPLETED course of treatment must be submitted to the BSA. If a completed COT is submitted outside of this time frame then the claim will not be scheduled and the dentist will not be paid for the work completed.

    If what you are saying were true then many denture patients would have their course of treatment closed before they reach fit stage given that most dentures will require a minimum of 4 appointments 5-7 days apart. If you add to that additional appointment when special trays or re-try's are required plus allowances for appointment availability then many patients could find themselves paying a band 3 charge twice!
    • brook2jack
    • By brook2jack 3rd Feb 17, 7:41 AM
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    brook2jack
    I'm sorry but it is true as individual ccgs and health boards have tightened up and if it's two months since the last appointment they flag it up as a late submission and will not pay, even if it's an incomplete course of treatment . Two months is mentioned in the contract as a basis for all treatment to be finished in, it is also the cut off for continuation of a course of treatment if in the same band. It's another example of them moving goal posts not in the original contract.

    Most practices will have notices with this up.

    In the case of dentures two months does not elapse between appointments due anyway it's four appointments with a week in between.

    The op had kept one appointment , cancelled one appointment ,then made a second one for two months after the previous appointment. They should have been warned that a new course of treatment would have been opened with a fresh set of charges.
    Last edited by brook2jack; 03-02-2017 at 8:40 AM.
    • Firtree85
    • By Firtree85 3rd Feb 17, 7:33 PM
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    Firtree85
    The NHS dental contract:

    "42. The Contractor shall use its best endeavours to ensure that a course of treatment is completed, and that it is so completed within a reasonable time from the date on which—

    42.1. the treatment plan was written in accordance with clause 47; or

    42.2. where a treatment plan is not required pursuant to clause 51, the initial examination and assessment of the patient took place."

    The two months mentioned in the contract relates to the submission of a completed course of treatment:

    "Notification of a course of treatment or orthodontic course of treatment

    221. The Contractor shall, within 2 months of the date upon which-

    221.1. it completes a course of treatment in respect of mandatory or additional services;

    221.2. it completes a case assessment in respect of an orthodontic course of treatment that does not lead to a course of treatment;

    221.3. it provides an orthodontic appliance following a case assessment in respect of orthodontic treatment;

    221.4. it completes a course of treatment in respect of orthodontic treatment;

    221.5. a course of treatment in respect of mandatory services or additional services or orthodontic course of treatment is terminated; or

    221.6. in respect of course not falling within clause 221.4 or 221.5, no more services can be provided by virtue of clause 44.2 or 148.2

    send to the PCT, on a form supplied by the PCT, the information specified in clause 222."

    The patient has paid for two band 2 courses of treatment within the space of 4months (July to October) without:
    1) ever having failed to attend an appointment
    2) cancelling an appointment with less than 24 hours notice
    3) having had any communication from either the dentist or practice reception team asking them to attend for an appointment sooner than the one that was booked
    4) (presumably) having signed a new FP17DC
    5) having any new fractures or caries since the initial checkup

    The only way in which the dentist would have been able to close the first course of treatment without completing all items is to mark the patient as failed to return.

    Operating in this way is extremely risky. The NHS vital signs flag up patient reattendence within 3-6 months, percentage of discontinued courses of treatment and number or banded courses of treatment without an exam (meaning the patient would have had to have had another exam at the opening of the second COT).

    Providing the way in which the patient has described events is accurate, if they were to complain to the NHS it is highly likely that this case would be investigated as inappropriate claiming. The NHS would most certainly investigate the level of communication made by the practice and whether or not reasonable effort was made to provide them with an appointment within a more suitable timeframe.
    • brook2jack
    • By brook2jack 3rd Feb 17, 8:58 PM
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    brook2jack
    Pcts do not exist anymore, and the way ccgs and lhbs administer the contract falls far outside their original remit.

    But op had check up, some fillings done , an appointment for further fillings which they cancelled and then they made a new appointment at a later date , because of their work schedule for over 2 months later. The practice had made appointments in an appropriate time , they sent reminders , as a result of which an appointment was rearranged.

    Op chose to make the appointment for over two months in the future. They should have been warned that the first course of treatment would be shut down and a new charge would ensue but the length in between appointments was not due to the practice , which had scheduled appointments quickly and was not "splitting treatment". Many practices have signs and entries in their websites warning about this e.g. Here http://www.pontesburydental.co.uk/patient-information/

    You cannot send off a band two treatment without doing a new check up and you can argue that someone who needs four fillings in a course of treatment shouldn't be left four months without having another check up anyway.

    The practice is not "gaming " it made appropriate appointments and the length of time in between appointments was due to ops work schedule, when the new appointment was made.

    Many practices now have notices in waiting rooms warning that leaving too long in between appointments may result in courses being closed down. This is a particular problem around the end of the NHS financial year when NHS practices are penalised if they don't hit UDA targets and treatment carried over into a new year doesn't count for previous years targets.

    As you say many, many parts of a practice are monitored statistically and practices that are out of line are penalised very heavily. It can be argued that a practice that has made three appointments for a band two treatment is already heavily financially penalised .
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