Dental costs / fine, please help

katrina123

hi, popped into local NHS dentist to ask if i could get treated / check up and if it would cost me, they said it would
be for free as i was on ESA, so they asked for proof, i took esa proof, they signed me up, then i had some treatment, over 2 visits, at no charge.

Few weeks later recieved letter from nhs, routine check unable, so please send proof of esa and fill in questionnaire.
totally forgot about this, was going to go to dentist to sort it out. then i get another letter from nhs, ie pentalty charge notice and fine, totalling a sum of over £300! if dont pay, debt recovery, county court, more charges.

So i go to my dentist with my paperwork, they say if im on esa its fine, there should be no costs and thats its between me and the nhs as dentist did not charge me, so i need to proov to them now. So im now so stressed and already got mental health problems and awaiting urgent psychiatrist help and on some strong medication...i dont how to deal with this.

I cant afford this cost, i only went to dentist as they said it was free to me.

looking at my esa paperwork and nhs letters, i think it might be to do with income based esa or contribution based.
around the same time of dental treatment i was switched from one to another, i believe from contribution to income, but the switch over date was just after dental treatment, but surely the dentist would have checked this? i took some ESA paperwork with me to dentist and they inspected it and gave me the go ahead for free treatment.

the dentist has assured me, all esa claiments do not have to pay, twice now.

do i need to go to cab?
debt advisor?

i dont know how to deal with this. i simply can not afford this Fee, i am in debt and cant even afford rent and food, im overdrawn, and on esa, unfit to work, no savings.

can anyone advise please? thankyou

mynameistallulah

No, it is not for the dentist to determine that you are on the correct type of benefit. You are correct, you need to be on income based ESA at the time of treatment. The best thing you can do now is contact the NHS and explain that you forgot to return the paperwork, and ask if you can do it now.

nannytone_2

are you sure you were swapped from contribution based ESA to income based ESA and not from incapacity benefit to contributions based ESA?

if youre on contributions based ESA, you would have no automatic right to free dental care, but would have needed to apply for an excemption certificate.

p00hsticks

This was discussed on Moneybox recently - I can't recall exactly what was said but y u can listen to the program again here

http://news.bbc.co.uk/2/hi/programmes/moneybox/9725704.stm

METAL_MICKEY

The letter you will have received will be from the NHSBSA Dental Services in Eastbourne.

I can advise you how to get the civil penalty charge waived but in all likelihood you will have to still pay the cost of the actual NHS charges athough they will accept instals based on you providing them with a financial statement.

1) Go to your GP and see if he will provide you with a letter to state that you have sufficient mental health issues that would impair your judgment in respect of understanding your benefits and/or reading and signing forms associated with them. If he agrees send this to the NHSBSA in Eastbourne.

2) In conjunction with 1) above politely approach your dentist and see if he will write a letter to confirm that his surgery staff inspected your ESA documentation and that they directly advised you that based on that paperwork you were entitled to free treatment. The crucial element here is to be polite and a good dentist will want to maintain good relations with patients. Crucially if the dentist does ack an error on behalf of his staff there is no comback on his staff from the NHSBSA (unless there were dishing out poor advice wholesale). You could also supply subtle pressure on the dentist by saying that you are really unhappy with what has happened and indicate that you may make a complaint to his PCT (Primary Care Trust). The PCT hold his NHS contract and most dentists will shy away from any complaint issue that may get them involved.

3) Have a careful look at your ESA entitlement letter that the DWP (Job Centre) will have sent you. As previous poster said the key issue is that it is only Income Based ESA that entitles you to free dental treatment whilst Conts Based does not. However, there is crucial problem with most of the standard ESA letters in that where they indicate your benefit amount there is a potentially misleading sentence that states something along the lines of "we call this Income Related & Contributions ESA". In essence you should bring this sentence to the NHSBSA's attention and state that it is ambigous in that it states both types of ESA but without clearly indicating which one you are in receipt of. Very politely suggest that should they wish to issue a civil court claim for recovery of the Penalty Charge this will form the mainstay of your defence. You could also throw in that you will bring the matter to the attention of the Health Service Ombudsman.

4) There is no point in returning the questionnaire they sent you now. You have been fined for making an incorrect benefit claim and not for failing to return the quest.

5) Do not waste time by arguing that you simply did not understand your benefits and/or you simply failed to carefully read the little blue PR form you signed at the dentist. The NHS Penalty Charge is a tough piece of legislation and even in civil law ignorance is not a plea. Dont bother threatening to write to your MP! That defence fails 100% because your MP has no power over the NHSBSA and civil debt recovery. They will simply bat that defence away.

6) When you phone Eastbourne ensure you are polite at all times and make a point of asking for the name of the operator you are talking to. If you get no joy from the first person you speak to request that you personally speak to the manager Mrs Stonard.

7) If they do agree to waive the penalty charge you should then confirm that you are prepared to pay the NHS charges by instalments. They should then send you a form for you to detail your financial circumstances. Do not let them bully you into paying over 6 months and insist that they send you the AFC form. If you have trouble filling in the form go to your local CAB and make sure they specifically include details of any priority debts you have. If at any stage during instalment discussions they are unreasonable you should request that they send you all their policy documents in respect of how they fairly determine repayment rates. You could also ask that they send you the details of how their Debt Recovery policy aligns with debt enforcemjent legislation since they are not covered by the Consumer Credit Act.

8) Dont be put off by them mentioning issuing a Court claim. Its all intended to frighten you. If they dont budge on waiving the Penalty you could simply submit a written defence to their claim highlighting the points 1-3 above. You do not have to personally attend any associated civil court hearing and you can submit a written defence. Alternatively, you can attend your local court and it is very informal and they will NOT send a claimant representative so it will not feel like a criminal court. Quite simply get your paperwork sorted, be polite to the judge and state your case.

8) If worst case scenario is that they wont drop the penalty just insist that you pay by instals.

I appreciate all of the above is quite a lot to take in but it should help. If you have any further questions please post here or PM me. Good luck

METAL_MICKEY

nannytone wrote: »

are you sure you were swapped from contribution based ESA to income based ESA and not from incapacity benefit to contributions based ESA?

if youre on contributions based ESA, you would have no automatic right to free dental care, but would have needed to apply for an excemption certificate.

Just to expand on that point you need to apply for what is called an HC2 Low Income Scheme Certificate. You apply for this by completing an HC1 application form which can be obtained from Job centres and some GP's/Dental surgeries have supplies. Any resultant HC2 issued will run for 12 months and it should clearly state the expiry date and the people covered by the exemption claim. This form does not automatically renew so a month before bit expires you have to go through the application process again. This is logical since there may be a change in your circumstances.

When you attend for dental treatment you should always clearly sign the little blue PR form to say you have an HC2 and show the receptionist your certificate.

Anyone who is not on a 'means' tested benefit but believes they have a low income should do this. Even if you are not issued an HC2 because of your income level they may issue an HC3 partial exemption certificate which will state that you only have to pay a certain amount towards your dental treatment.

As nannytone states this process is crucial to anyone still on Incapacity or Disability benefit or who has been moved to Conts Based ESA. If you are currently claiming free treatment on the basis of IB/DLA or Conts ESA you are risking having to retyrospectively pay the cost of the NHS treatment plus a fine of £100.

I hope this helps some people on here.

katrina123

thankyou all, especially metal mickey.
CAB are helping me, I need to get a letter from GP supporting my case, as metal mickey says.
This is all so confusing, i havnt got a grip on it yet, planning on sending explanation letter, proof of illness, doctor letter, proof of esa letters, all to nhs, see if they will reconsider.
There was no mention of low income scheme or refund or reduced rates if i would be eligable for them, when cab spoke to nhs. They just seemed to say, appeal it asap with gp letter.

any ideas on how the GP letter should be worded?

thankyou

METAL_MICKEY

The letter from your GP must as i have advised and as now advised by the NHSBSA in Eastbourne must state that

" at the time when you signed the PR declaration form you were suffering from mental health issues that would have directly effected your ability to understand your benefits and your ability to understand and read the form that you signed".

It need only be as simple as that to get the £100 Penalty fine removed. If your GP is prepared to state that you have "severe and enduring" mental health issues there is the outside chance that they may consider cancelling the whole debt including the NHS dental charges. However, that must be the truth and of course your GP and/or another medical professional must be prepared to state that. If you have ever had suicidal tendencies that should also be mentioned. I totally appreciate this is very personal stuff but they should if they follow procdure pick up on key aspects like that. They will also treat such information with strictest confidence. Unfortunately, most GP's now charge for very basic letters.


Do not take any notice of what your dentist or his staff say. Too many of them give poor advice and are largely not accountable for people having to pay retrospective charges and/or penalty charges. There is even a disclaimer on the form saying that he is not responsible for what you sign. Every NHS patient who thinks they are entitled to free treatment MUST carefully read the form they ask you to sign. If you are in any doubt as to whether you are entitled you should pay the dentist directly, retain the NHS receipt and then double check your precise benefit situation with the relevant benefit agency. If the agency says you hold a qualifying benefit, patients can then obtain a refund of the NHS charges by completing an HC5 form which needs to be sent to the NHSBSA in Newcastle. The dentist does not directly refund the patient. Similarly, you can at that point actually apply for a qualifying benefit and if it is granted you can then apply for a refund. However, it is crucial that you apply for any refund within 3 months of when you actually paid the dentist.

Many CAB's wrongly advise and are themselves confused by the 3 month refund rules. If you have been subject to a random check by the NHSBSA Dental services in Eastbourne you CANNOT pay the NHS charges retrospectively to them, obtain a a qualifying benefit and attempt to get them to give you a refund even if it is within 3 months from when you paid them. This is totally illogical and many CAB's and patient representative groups get this wrong and give false hope. It would not make any sense for an NHS body to spend time & money to identify and recover the NHS charges in one hand and then give them straight back to you with the other.

The letters from the NHSBSA in Eastbourne whilst mentioning the word "fraud" do make a big point of not actualy accusing you of fraud. The inclusion of that word is highly contentious as it naturally angers people who have made a genuine error. However, it justifiably does panic those that do deliberately evade NHS charges so its a double edged sword.

The biggest problem is that the NHSBSA operation in Eastbourne has been outsourced to a private company who have a name that sounds very much like CRAPITA who are well known in the world of business process outsourcing. Unfortunately, neither the NHSBSA or that company have any interest in trying to focus their benefit checks on those deliberately evading NHS dental charges. The reality is that such a focus maybe be more diffcult, not cost effective, and may require greater cooperation from 3rd parties such as NHS dentists and primarily the hugely inefficient, disorganised and overworked beast that is the DWP who administer most benefits. By the same token HMRC would have to be involved as they sort out tax credits which historically has also been at times a shambles.

Bottom line is that its easier and cheaper to chase patients who have made genuine mistakes. Plus whilst the NHS charges get paid back in the PCT coffers, would anyone care to guess where the Penalty charge goes?:mad: