A warning - tax credits and claiming free nhs dental treatments

mummyroysof3

we have received cards in the post before but not this year has the qualifying terms changed?

METAL_MICKEY

GlasweJen wrote: »

Same goes for the opticians, you only get the voucher if you have an exemption card.

I'm in Scotland so we use the GOS 3 form to issue an optical voucher and it has a "evidence not produced box". The reason we sometimes don't get evidence is the person is aggressive if you ask to see proof and it's easier to get a signature and cross the box rather to put yourself at risk. The guidelines for the form state that this is acceptable.

I'm glad that there's a clamp down on NHS fraud, sometimes there are days where every other customer is on income support with no evidence and they are using their £37.10 voucher towards designer glasses with thinned down drivewear or transition lenses at £300+. I know that some people on benefits save for nicer glasses than the voucher covers but really, drivewear have a permanent tint on them and you need a decent pair of clear glasses to go with them so it's an expensive, non-clinical, purchase for someone who is supposed to be on the bread line.

Thats not something that surprises me. Many dental surgery do experience aggressive patients when asking for proof so the system does have some practical real word operational problems. However, for those surgeries that do always ask it wrongly implies to the patient that they are then subsequently approving the evidence that is shown to them. Of course the dental PR forms in the small print then do clearly refute this and state that the patient is wholly responsible for the accuracy of the claim. My previous post explains how the evidence seen procedure is a mess.

Ironically, a few months back i found myself on JSA for the first time in my life. On attending Vision Express for an eye test i was chatting to the optomertrist and mentioned i had been made redundant. At which point he joyfully explained that because i was unemployed i could claim a free sight test. I politely refuted this and exlplained that you needed to be in receipt of JSA and it must be Income Based and i was on Conts based. He was however politely insistent and went out to get a copy of the form. On his return he expressed his surprise in that a closer inspection of the forms wording confirmed the JSA issues. In short, here was a well meaning professional (not some ditzy poortly paid dental receptionist) who was unwittingly inviting me to make an incorrect benefit claim. Now had i taken his advice the local PCT could through their checks later have presented me with a request for the cost of the sight test plus a civil penalty charge which i could not defend on the basis of ignorance and/or being misadvised.

Clamping down on benefit fraud is crucial. However, currently when it comes to patient dental exemption claims the vast number of NHS charge recovery and penalty claims do not come from those deliberately making incorrect claims. However, the amounts recovered are keeping the NHSBSA accountants happy and CRAPITA are keeping the penalty!

METAL_MICKEY

mummyroysof3 wrote: »

we have received cards in the post before but not this year has the qualifying terms changed?

Just to expain its the HMRC who analyse your tax position but then they pass on the result to the NHSBSA in Newcastle who arrange the issue of the Tax Credit Exemption Certificates (as you know it is in fact a little white card and not an A4 doc as the word certificate wrongly suggests).

Accordingly you should contact HMRC to see whether:

A) Your are no longer entitled because the qualifying terms have changed

The financial details you have supplied clearly indicate a change in your circumstances and therefore you no are no longer entitled under the existing terms

C) Or hopefully there may be simply an administrative delay in the issuing of the TCEC cards.

In the interim if you attend an NHS dentist make sure you do pay them directly the NHS charges but make sure they issue you the NHS receipt. If it transpires that you were entitled and the cards eventually get issued you will need to complete and send an HC5 form to Newcastle along with the receipt and they will refund you. Its important to note that you must apply for the refund within 3 months of having paid the charge.

GlasweJen

METAL_MICKEY wrote: »

Thats not something that surprises me. Many dental surgery do experience aggressive patients when asking for proof so the system does have some practical real word operational problems. However, for those surgeries that do always ask it wrongly implies to the patient that they are then subsequently approving the evidence that is shown to them. Of course the dental PR forms in the small print then do clearly refute this and state that the patient is wholly responsible for the accuracy of the claim. My previous post explains how the evidence seen procedure is a mess.

Ironically, a few months back i found myself on JSA for the first time in my life. On attending Vision Express for an eye test i was chatting to the optomertrist and mentioned i had been made redundant. At which point he joyfully explained that because i was unemployed i could claim a free sight test. I politely refuted this and exlplained that you needed to be in receipt of JSA and it must be Income Based and i was on Conts based. He was however politely insistent and went out to get a copy of the form. On his return he expressed his surprise in that a closer inspection of the forms wording confirmed the JSA issues. In short, here was a well meaning professional (not some ditzy poortly paid dental receptionist) who was unwittingly inviting me to make an incorrect benefit claim. Now had i taken his advice the local PCT could through their checks later have presented me with a request for the cost of the sight test plus a civil penalty charge which i could not defend on the basis of ignorance and/or being misadvised.

Clamping down on benefit fraud is crucial. However, currently when it comes to patient dental exemption claims the vast number of NHS charge recovery and penalty claims do not come from those deliberately making incorrect claims. However, the amounts recovered are keeping the NHSBSA accountants happy and CRAPITA are keeping the penalty!

I have the opposite problem! Patients come in and gleefully announce that they've been made redundant and they want their free glasses. I've twice been reported to practitioner services for refusing to give them freebies. One instance was because the person wasn't due an eye test so even if she was on the correct benefit no glasses would be forthcoming, the other was a person who had been made redundant and was on CB-JSA and his paperwork stated this.

We now have everyone ask to see evidence and get it photocopied but we do have at least 1 aggressive person per day (rough area in Glasgow) who gets the box crossed and sent off.

I think they should issue the wallet card to everyone who is entitled to NHS health costs help and not just the tax credit lot.

METAL_MICKEY

GlasweJen wrote: »

I have the opposite problem! Patients come in and gleefully announce that they've been made redundant and they want their free glasses. I've twice been reported to practitioner services for refusing to give them freebies. One instance was because the person wasn't due an eye test so even if she was on the correct benefit no glasses would be forthcoming, the other was a person who had been made redundant and was on CB-JSA and his paperwork stated this.

We now have everyone ask to see evidence and get it photocopied but we do have at least 1 aggressive person per day (rough area in Glasgow) who gets the box crossed and sent off.

I think they should issue the wallet card to everyone who is entitled to NHS health costs help and not just the tax credit lot.

Your experience highlights the absurdity of the situation. Dental surgery staff are supposed (i use that phrase since there is no effective audit on surgeries to ensure they are asking) to ask for evidence but if nothing is seen under NO circumstances are they or the dentist allowed to refuse treatment. Similarly, they are not encouraged to offer a defintive opinion to the patient as to whether anything they show is valid evidence of a qualifying benefit.

Photo copying what is shown is also largely pointless and can present possible problems on subsequent visits. If a retrospective check on an exemption claim on optical or dental charges indicates an incorrect claim, a patient can't appeal against the NHS penalty charge on the basis that the dentist/optician took a photocopy thereby suggesting that THEY endorsed the docs as valid proof of qualifying benefit. The docs signed by patients claerly state that they are wholly responsible for the accuracy of the claim.

Many dental surgeries also have a bad habit of sitting on photocopies of "evidence" and do not take the time to ensure that on all subsequent visits that the validity period has not expired. Some really slack surgeries based on this retention also tend to absurdly assume that where a patient was exempt once then surely they must still be on subsequent visits. This is also componded by a major problem with many dental surgery software where the patients exemption status is "rollled" over from their previous claim to their new claim i.e. instead of the field defaulting to a blank it has an entry to signify that they are still exempt. In turn this encourages some surgery staff to prefill the blue PR form declaration with an X and then they just hand it to the patient to sign who often doesn't bother to read it. Now the conscientious patient will at that point raise a query particularly when they not asked to pay anything. However, some patients perhaps naively just leave the surgery with an expectation that they will be billed in the post. Then imagine their surprise when the NHSBSA in Eastbourne send them a letter demanding a bill of £309 (If a Band 3 treatment with max pen charge) that mentions fraud and CCJ's


The solution is not rocket science and certainly in dental sugeries the following script should be adhered to:

Please can you show me documentation that YOU believe is proof of a qualifying benefit. Please note that retrospective checks are made on claims whether documentation has been shown or not, and in the event of an incorrect claim you will be wholly responsible and ignorance of your benefits or failing to read your declaration is not a defence. I am not able to endorse the validity of your evidence but can only advise that if you are in any doubt you should pay for your services now and claim a refund if its subsquently proven that you do hold a qualifying benefit".

Now even if most dentists would baulk at their staff going through that dialogue their PCT's should make it a requirement that the essential message is reproduced on nice clear waiting room notices.

Unfortunately, this will never happen as the NHSBSA and govt are still tip toing around the dental profession due to the appalling mess of their new contacts. More importantly, the NHSBSA and its bean counters are happy with the amount of NHS dental charges recovered despite them coming from too large a proportion of genuine mistakes exacerbated by poor information supplied by the relevant benefit agencies such as the DWP & HMRC. And the irony being that this flies in the face of agencies like NHS Protect who wish to claim that every effort is made to chase patient fraud in the NHS when in reality the system is just hunting soft targets. And the icing on the cake is that CRAPITA who are the outsourcing company entrusted with the debt recovery have no regard for the principles of the NHS and are gleefully going to rake in even greater penalty charge amounts when they supposedly instigate 100% checks.

duchesspink1

really its up to the patient to find out from their benefits office if they are entitled to free dental treatment due to their benefit and not at all up to the dental receptionist, nurse or dentist to find out for them.

There are so many different benefits and variations of rules on each benefit that a dental practice team couldn't possibly know the rules for each case. In our practice we ask if the patient if they are exempt, show them the list of exemptions and ask if they have one of them. if the patient has an exemption, then they must provide proof and if they don't provide the proof then the surgery will take their word that they are actually entitled to free treatment and its up to the dental board that pays for it to make the appropriate checks otherwise.

If you are the patient and have ticked for your treatment, then you will obviously have to pay it back if you have wrongly claimed exemption.

Surely if you get a benefit, its up to you to know what it entitles you to?

METAL_MICKEY

duchesspink1 wrote: »

really its up to the patient to find out from their benefits office if they are entitled to free dental treatment due to their benefit and not at all up to the dental receptionist, nurse or dentist to find out for them.

There are so many different benefits and variations of rules on each benefit that a dental practice team couldn't possibly know the rules for each case. In our practice we ask if the patient if they are exempt, show them the list of exemptions and ask if they have one of them. if the patient has an exemption, then they must provide proof and if they don't provide the proof then the surgery will take their word that they are actually entitled to free treatment and its up to the dental board that pays for it to make the appropriate checks otherwise.

If you are the patient and have ticked for your treatment, then you will obviously have to pay it back if you have wrongly claimed exemption.

Surely if you get a benefit, its up to you to know what it entitles you to?

That's very nice theory and in a perfect world i would totally agree that a dentist does not employ his surgery staff to manage and understand the benefits of their patients. However, if you take a closer look at all the NHSBSA advice on the process their are contradictions and mixed messages. From my experience many dental surgeries with minimal effort and perhaps a little help from the PCT could reduce the the number of incorrect claims. There could be a standardised set of waiting room advisory posters whiich might address the fact that too many patients fail to read the PR form before they sign and in defence of that many surgery staff barely afford them the time to read it and they prefill the form by putting the cross on!

The reality is that the benefits system is over complicated for surgery staff and patients alike. It maybe that the Universal Credit may simply things to a degree but in the interim the powers that be need to need to be proative rather than simply reactive by dishing out £100 penalty charges.

Todays quiz for you surgery staff (and no looking it up on Google please

1) A patient says they are unemployed and shows you their signing on book - Whats your response?

2) A patient says they entitled to free treatment on the basis of a war pension- Whats your response?

3) A patient says they are on ESA and shows you their DWP letter confirming ESA- Whats your response

4) A patient shows you a Tax Credit Exemtion Certificate that that has just expired and your records indicate that they have had previous exempt claims where you have taken copies of the little white card- What;s your advice

5) SPECIAL BONUS QUESTION NOT RELATED TO EXEMPTION CHECKS- A patient with no real major periodontal problems gets a little upset that you insist they make an appt with yout practice hygienist at a privaye charge cost of £40. How do you react?

Paperweight

WE get tax credits and were told by their helpline that we would be entitled to free dental care etc. However, I decided to wait for the exemption card to arrive. After 8 weeks I rang the TC helpline again and they confirmed that with our income we should have received the card. They advised me to chase the people that issued the card. When I did that the card people told me that they had not been instructed by HMRC to issue the card and that I should take it up with them. Another call to the TC helpline and this time after a long hold I was told that we were not entitled to the exemption card after all. Apparently although our income was below the threshold for entitlement, we had a £2500 disregard because our income was higher last year. After taking the disregard into account we exceeded the threshold and therefore were not entitled to the exemption card.:mad:
We were advised however to apply for exemption through an NHS low income scheme. If successful we would receive an HS2 exemption certificate which entitles us to the same benefits as the TC exemption form. I also understand that even if your income is too high to receive full exemption, you may still be entitled to partial exemption.
I still wont be spending any money at the dentists though until I actually have the certificate in my hand.

METAL_MICKEY

Paperweight wrote: »

WE get tax credits and were told by their helpline that we would be entitled to free dental care etc. However, I decided to wait for the exemption card to arrive. After 8 weeks I rang the TC helpline again and they confirmed that with our income we should have received the card. They advised me to chase the people that issued the card. When I did that the card people told me that they had not been instructed by HMRC to issue the card and that I should take it up with them. Another call to the TC helpline and this time after a long hold I was told that we were not entitled to the exemption card after all. Apparently although our income was below the threshold for entitlement, we had a £2500 disregard because our income was higher last year. After taking the disregard into account we exceeded the threshold and therefore were not entitled to the exemption card.:mad:
We were advised however to apply for exemption through an NHS low income scheme. If successful we would receive an HS2 exemption certificate which entitles us to the same benefits as the TC exemption form. I also understand that even if your income is too high to receive full exemption, you may still be entitled to partial exemption.
I still wont be spending any money at the dentists though until I actually have the certificate in my hand.

The essential question here is whether your treatment is urgent i.e. are you in pain? To apply for the HC2 certificate you need to complete and send off the HC1 application form. In the interim period you can attend the dentist and simply sign as a fully paying patient and hand over the cash and keep the NHS receipt safe. If the HC2 is then issued you have a 3 month period from the date you paid to apply to the NHSBSA for a refund by using an HC5 form. The surgery will not refund you directly.

You should never sign as an exempt patient on an assumption that you are going to get the qualifying benefit. If you make that mistake and you come up on the NHSBSA checks as not having the benefit you will be asked to repay the NHS dental charges and will receive a penalty of £100. The penalty will not be waived if you claim to have been misadvised by the agency and/or dentist.

If you are not given an HC2 full exemption certificate they may send you an HC3 partial exemption certificate, This will clearly state an amount you should contribute towards and course of dental treatment. HC2/HC3's are not renewed automatically so a month before it expires you have to apply again via a new HC1.

Make sure you and any partner are both named on the top right of the HC2/3 certificate. Many people get a penalty charge because they too literally interpret some wording on the main body of the certificate which states that "you and and any partner are entitled to claim". This obviously only applies to a partner whose details were included in the original HC1 application and hence their name is also on the top right of the certificate. By the same token people who received the Tax Credit Exemption Certificate should make sure that both partners are issued with their own distinct card.

Hope this helps

duchesspink1

METAL_MICKEY wrote: »

That's very nice theory and in a perfect world i would totally agree that a dentist does not employ his surgery staff to manage and understand the benefits of their patients. However, if you take a closer look at all the NHSBSA advice on the process their are contradictions and mixed messages. From my experience many dental surgeries with minimal effort and perhaps a little help from the PCT could reduce the the number of incorrect claims. There could be a standardised set of waiting room advisory posters whiich might address the fact that too many patients fail to read the PR form before they sign and in defence of that many surgery staff barely afford them the time to read it and they prefill the form by putting the cross on!

The reality is that the benefits system is over complicated for surgery staff and patients alike. It maybe that the Universal Credit may simply things to a degree but in the interim the powers that be need to need to be proative rather than simply reactive by dishing out £100 penalty charges.

Todays quiz for you surgery staff (and no looking it up on Google please

1) A patient says they are unemployed and shows you their signing on book - Whats your response? " are you in receipt of any of these benefits?" show patient the form and ask them to tick what they are in receipt of

2) A patient says they entitled to free treatment on the basis of a war pension- Whats your response? "are you in receipt of any of these benefits?" show patient the form and ask them to tick what they are in receipt of

3) A patient says they are on ESA and shows you their DWP letter confirming ESA- Whats your response "Can you please tick which of these benefits apply to you"

4) A patient shows you a Tax Credit Exemtion Certificate that that has just expired and your records indicate that they have had previous exempt claims where you have taken copies of the little white card- What;s your advice "You're tax credit exemption has expired, you will need to get confirmation that you are still entitled to free treatment before we can proceed"

5) SPECIAL BONUS QUESTION NOT RELATED TO EXEMPTION CHECKS- A patient with no real major periodontal problems gets a little upset that you insist they make an appt with yout practice hygienist at a privaye charge cost of £40. How do you react?

"the dentist has recommended that you see the hygienist and it is a private appointment, if you don't wish to book then i'll make a note and let the dentist know." we don't insist that anyone books anything they can't afford or don't agree to. we are offering a service and patients get to choose if they accept what is offered.

you're totally missing the point that its not the surgeries responsibility though, its up to the patient and really why on earth should the dental staff take any kind of responsiblity for ensuring patients claims are correct? Its up to the patient... end of. We are here to provide dental treatment, not a benefits enquiry service.

now to answer your tasks, i've been away for the weekend so forgive me for being slow in getting back to you.