NHS dental charges applied within same course of treatment 31 March 2021 at 1:02PM edited 31 March 2021 at 1:03PM in Health & beauty MoneySaving 9 replies 181 views

peadar

Last November I lost a crown. I paid a Band 1 fee for the appointment, then a Band 3 fee on top of that for a course of treatment that consisted of a crown plus a referral to a specialist for another tooth. The dentist said he'd been conservative with the crown height and it would likely need further adjusting.

5 months later the referral hasn't come through and the other tooth has given me grief. When I rang the dentist about it I also mentioned the crown was still a little high. They said I should come in, which I did - and had a slight adjustment to the crown. I pointed out that from my perspective this was part of the same course of treatment (the referral was still outstanding) and that in any case repair work to a crown isn't chargeable within one year, but the practice now wants yet another Band 1 or emergency treatment fee.

It seems every appointment is classed as 'emergency treatment'. The crown adjustment wasn't an emergency, but when I rang the day before to point that out and that the course of treatment hadn't finished, i was told I should come in anyway. Which I did.

Is the practice right and I should cough up? Or is filing a crown fitted less than a year ago (and before the full course of treatment has completed) classifiable as repair work that, according to the NHS website, should not be charged??

brook2jack2

You cannot reopen a course of treatment that has been sent off over two months ago. Although any adjustments to your crown would  be covered by your 12 month guarantee any time you see your dentist after a two month gap you will either need to have an assessment of needs or a complete check up. Both of these will generate , in England and Wales, a band one charge . 

In these covid times the dentist has to send off a form for every person they see or advise or speak to on the phone etc. So every visit you have will have to generate a course of treatment and , in this case, a charge. 

If you had been seen less than two months ago you would not have needed an assessment or check up as the old course of treatment could have been reopened. 

The rules are Byzantine and the dentist has no choice but to follow them . 

peadar

brook2jack2 said:

Although any adjustments to your crown would  be covered by your 12 month guarantee any time you see your dentist after a two month gap you will either need to have an assessment of needs or a complete check up.  

The course of treatment (as opposed to the dentist's personal involvement) has yet to be completed, but setting that aside: how does the 12 month crown guarantee work, if it's cancelled out by the two months from the end of the dentist's involvement in the course? 
Didn't have a complete check up, it was just filing down a few mm of height on the crown and chasing up the specialist referral.

My reading of the rules is that "If you have completed one course of treatment but you need another treatment, you do not have to pay again if....you need repair work or a replacement for crowns...within a year of the original work being done".

brook2jack2

You have been referred to another dentist for treatment , so your dentist will have sent off this course of treatment as their part is completed and have been referred on for other treatment. They cannot keep the treatment open whilst you wait for referral and indeed there is a box on the form to indicate you have been referred on. This is because eg in my part of the country you can be waiting up to three years for certain referrals. See page 5 and 6 here https://www.nhsbsa.nhs.uk/sites/default/files/2017-07/Completion%20of%20form%20guidance%20-%20FP17%20-%20England%20%28V9%29%20-%2007%202017.pdf

You have not been charged for the adjustment of the crown, any work on that would be covered by the guarantee but you will have been charged a band one charge for assessment , opening any course of treatment after two months will incur a band one charge for assessment or examination, even if you had eg the whole crown replaced under guarantee you would pay the band one assessment or examination fee as according to regulations crowns cannot be provided,even under guarantee , without a check up . 

peadar

Crowns often need minor adjustments. When he fitted it, the dentist said it was likely to need tweaking, but he would rather be conservative - file it down too little rather than too much. 
Are you saying that every single time a crown needs tweaking beyond two months, a new examination charge is incurred? I had one crown in the past when I was back and forward like a fiddler's elbow to get it filed or put back on, I'd be bankrupt if I'd paid every time! A crown of course isn't "provided" when it's adjusted. And no other teeth were 'examined' or 'assessed'.

And why would the first examination charge - the one that kicked off the crown plus referral course of treatment - have been added on to the band 3 charge rather than deducted from it?

brook2jack2

If your first appointment was an emergency appointment that generates a band one charge on its own. Any subsequent treatment is part of a seperate course and will be charged accordingly. 

peadar

brook2jack2 said:

If your first appointment was an emergency appointment that generates a band one charge on its own. Any subsequent treatment is part of a seperate course and will be charged accordingly. 

How does one tell if it was an emergency appointment? The course of treatment with the dentist actually took two months - two appointments one month apart. 
Again: do I pay every single time the crown needs tweaking? If I realise after a few meals that it's still a little too high, will I be charged another band one for 'assessment'?

And if I am now paying, not for adjusting the crown but for an 'assessment' or 'examination', should I not have had all my teeth checked? Or is it just an 'asssessment' to confirm that the crown was a little high as I said? Surely the latter 'assessment' is intrinsic to the process of adjusting the crown?

brook2jack2

Assessment is not a full examination of all your teeth, it is just that assesment. A dental chair in a cheap NHS practice costs £140 an hour to run in non covid times , more at the moment , with many fewer people seen each hour because of covid precautions. 

The NHS sets targets which dentists must hit or have money clawed back. In normal times around 80% of practices do hit their targets, in covid times they have reduced targets but most will still struggle to hit them so will face clawback. 

When you book an appointment at the moment you will be screened for covid over the phone and probably when you arrive at the practice . After you have left enhanced cleaning will be done. There will be fewer patients going through the practice. The dentist and staff have to wear more PPE than normal . All of this has to be paid for . So whilst any adjustments, remakes etc are covered by guarantee the assesment , which from the sound of it was not only of your crown but also of the matter for which you had been referred , is not and particularly at present times when dental practices are under pressure to hit targets which are very difficult to hit because although most are working the same or longer hours they are seeing fewer patients because of covid precautions and are facing large claw backs of funds at the end of the year there is no leeway for the practice not to send the form off . 

peadar

So every visit for an adjustment will generate a new charge? If it needs adjusting next week, I will have to balance that need against the cost of a further Band 1?

In real terms this contradicts the "you do not have to pay again" bit on the one year crown guarantee, given that 'assessment' is trivially and intrinsically part of any adjustment process. Perhaps there's a 'plain English' problem here: there is no parenthetical remark, footnote, or other qualifier on the NHS website explaining that you will, however, have to pay again for an 'assessment' prior to the adjustment or repair. It is not unreasonable to read "you do not have to pay again" as....'you do not have to pay again'.

I understand the practical issues around covid (has it actually changed any rules and forms though?). And from the individual dentist's perspective their job is done when the referral is sent off.

However, as these are NHS charges and NHS treatments, it is entirely intuitive for a patient being charged and treated to assume that a course of treatment remains incomplete until the final part of that course of treatment is, well, completed.

The implication of what you say is that when the actual treatment takes place as a result of the referral at some future point (and I was assured that the specialist treatment was part of the same course of treatment) the individual specialist will charge me again as the course of treatment is supposedly closed. 

Is that in fact the case?

brook2jack2

It depends on what you have been referred for eg hospital treatment or community is free, mandatory services also will not incur another charge but certain services eg sedation may incur a charge, see page 5 and 6 . https://www.nhsbsa.nhs.uk/sites/default/files/2017-07/Completion%20of%20form%20guidance%20-%20FP17%20-%20England%20%28V9%29%20-%2007%202017.pdf

As far as your dentist is concerned the rules say that treatment is finished as they have done their part. Any further treatment , unless it is guaranteed , will be charged for.

Dentists do not write the rules or the publicity for them. They are very complex and subject to rapid change and change in interpretation at the whim of health boards etc.
Particularly at the moment , if you pay for treatment , I would expect to pay a charge of some sort every time you see a dentist. 

Covid has made a massive difference in rules and forms , particularly in certain parts of the U.K. Each area has made different requirements and rules. 

You have to understand that dentists are not part of the NHS. Some are contracted to carry out specific numbers of treatments to specific timescales and rules set by the NHS. These rules are complex and Byzantine and subject to change all the time , often at short notice.