NHS free dental treatment expensive mistake

baz8755

A few months ago I started receiving ESA and during a trip to the dentist I was asked if I was on benefits to which I replied yes. So when I checked the form I ticked the ESA box and thought nothing more about it.....until yesterday.

I received a letter from NHS querying if I was entitled to free treatment with a warning that if I didn't respond in 30 days I would pay a penalty.

I called and after about 10 minutes with a very unhelpful gentleman and reading several times through my somewhat confusing benefit letter it was concluded that I was on 'the wrong type' of ESA and not entitled to free dental.

I asked how do I pay as it was an honest mistake and I am happy to pay what I owe, he replied I have to wait 30 days to receive my penalty letter and pay the fees plus £100 penalty.

No matter how I tried to explain it was an honest mistake and that I an willing to pay fees now he held firm on this position.

I then tried emailing the full situation to the NHS but was given the same non common sense but unwavering ruling that I was not entitled and must therefore pay the penalty.


As I have said, in hindsight and having it pointed out that there are different types of ESA I am more than happy to pay what is owed but I feel that being treated as if I have somehow tried to defraud the system and being penalised is unfair. If at any point someone had clarified that it was not the correct ESA I would obviously have not even tried to claim and given that I am receiving ESA as I am struggling with bills this is just going to make matters worse.

I am posting this firstly as a warning to others to be very careful when assuming your entitlement under your benefits but also to ask if there is any way to plead my case with the NHS as I have come up against a very bureaucratic solid brick wall

Brie

Have you tried going in to the dentist and paying the fee?  It might be enough to stop the system issuing you a fine.  

One would have thought it was better to give a warning rather than jump straight to fining someone.

elsien

Have you gone through their formal appeal process? It may be possible to argue that you had exceptional reasons for your belief that  you were entitled to free treatment.
https://covadvice.org.uk/wp-content/uploads/2019/04/NHS_penalty_charge_challenge.pdf
This would entail you explaining why you were unaware of the type of ESA and its implications.

if you’ve already made the appeal, and it sounds like you have, then Nhs complaints would be the next step. 

baz8755

elsien said:

Have you gone through their formal appeal process? It may be possible to argue that you had exceptional reasons for your belief that  you were entitled to free treatment.
https://covadvice.org.uk/wp-content/uploads/2019/04/NHS_penalty_charge_challenge.pdf
This would entail you explaining why you were unaware of the type of ESA and its implications.

if you’ve already made the appeal, and it sounds like you have, then Nhs complaints would be the next step. 

That is very helpful

I would have thought that they would allow me to challenge now prior to issuing the penalty (which they have already indicated they are planning to do), however I guess I will just have to wait to receive the penalty and lodge the appeal then.

TELLIT01

I have a lot of sympathy for anybody finding themselves in the same situation as the OP.  Until I started working for DWP I wasn't aware that there were 'contribution based' and 'income related' benefits.  Even when I started it took a while to get my head around them as, to me, I had been entitled to 'contribution based benefits' because of my income - so doesn't that make 'contribution based' benefits income related?????.  DWP letters have always been notorious for being extremely difficult to understand too.

calleyw

TELLIT01 said:

I have a lot of sympathy for anybody finding themselves in the same situation as the OP.  Until I started working for DWP I wasn't aware that there were 'contribution based' and 'income related' benefits.  Even when I started it took a while to get my head around them as, to me, I had been entitled to 'contribution based benefits' because of my income - so doesn't that make 'contribution based' benefits income related?????.  DWP letters have always been notorious for being extremely difficult to understand too.

But as claimee you are responsible to know what benefits you are claiming.  And if you are not sure then you ask. Unless there is a cognitive/learning disability then there is no reason not to.   

Until my (now ex) husband had a stroke I had no knowledge of the benefit system.  But I spent the time to learn even though I worked full time and was carer for my husband, as well as doing all houseold chores.  I learnt how to fill his forms in to claim for his benefits.  And learnt the difference between contribution based and income related benefits and what we could and could not claim.

Spoonie_Turtle

In all fairness the ESA letters are particularly confusing.

My claim is for New-Style ESA which has never had an income component, it cannot.  My claim started long after new claims for income-related ESA were ended.

Yet my ESA letters about how it's worked out still make reference to income.  And there is no explicit mention of what kind of ESA it is, anywhere.

So I can fully understand how people can be unsure of what their exact claim is for, especially when people have usually started their claim during a time of distress and upheaval when their mental faculties have been stretched in all directions.  Even phoning DWP to ask may not result in correct information (if phoning is even accessible to someone - for many of us it's not, it takes a huge amount out of us and if we phone DWP it could literally be the only thing we're able to do that day).  

While yes it is technically the claimant's responsibility to know, the reality is that for many people that responsibility is disproportionately onerous. 

And then you end up with people making genuine but expensive mistakes like this, because the system is so confusing and opaque.

HillStreetBlues

Spoonie_Turtle said:

In all fairness the ESA letters are particularly confusing.

My claim is for New-Style ESA which has never had an issue component, it cannot.  My claim started long after new claims for income-related ESA were ended.

Yet my ESA letters about how it's worked out still make reference to income.  And there is no explicit mention of what kind of ESA it is, anywhere.

I can fully understand how people can be unsure of what their exact claim is for.  Even phoning DWP to ask may not result in correct information (if phoning is even accessible to someone - for many of us it's not, it takes a huge amount out of us and if we phone DWP it could literally be the only thing we're able to do that day).  

While yes it is technically the claimant's responsibility to know, the reality is that for many people that responsibility is disproportionately onerous. 

And then you end up with people making genuine but expensive mistakes like this, because the system is so confusing and opaque.

I was just about to make a comment like yours, but you did it so much better than I would of.

Once everyone on legacy benefits are  moved over to UC this kind of confusion should thankfully stop.

baz8755

Thanks everyone for your updates, I have now managed to get my case escalated to the complaints team and await the outcome.

I now know that I am not entitled and feel that given I am probably not the first person to make this mistake a far fairer system would be a warning along with request for payment of fees for a first invalid claim and then start issuing penalties for any claims made after the claimee has been notified.

Given that my claim was made a couple of months ago it is perfectly conceivable to have made many claims prior to being notified and therefore be issued many penalties, therefore you would definitely need to make sure that you do not issue penalties until claimee has received notification but just reclaim the fees.

Muttleythefrog

calleyw said:

TELLIT01 said:

I have a lot of sympathy for anybody finding themselves in the same situation as the OP.  Until I started working for DWP I wasn't aware that there were 'contribution based' and 'income related' benefits.  Even when I started it took a while to get my head around them as, to me, I had been entitled to 'contribution based benefits' because of my income - so doesn't that make 'contribution based' benefits income related?????.  DWP letters have always been notorious for being extremely difficult to understand too.

But as claimee you are responsible to know what benefits you are claiming.  And if you are not sure then you ask. Unless there is a cognitive/learning disability then there is no reason not to.   

Until my (now ex) husband had a stroke I had no knowledge of the benefit system.  But I spent the time to learn even though I worked full time and was carer for my husband, as well as doing all houseold chores.  I learnt how to fill his forms in to claim for his benefits.  And learnt the difference between contribution based and income related benefits and what we could and could not claim.

As above... the DWP have a responsibility to make it clear what you're getting and sadly ESA letters do not do that... they're misleading/confusing especially in reference to calculation of income related amounts. Worse... I have called them in the past (in the days when someone answered your call before you suffered symptoms of rigor mortis) to ask which I was getting and got a response "both income related and contribution based" which at best is also confusing and it turned out I was in practice getting C-based which I asked to change so I could get Enhanced Disability Premium added and which IIRC is named completely differently (Disability Income Guarantee) on these same award letters. (The words of my old boss linger 'anyone who uses more than one name for the same database field will be thrown out through the window... and then a gaping hole in the wall if they prefer to call it that on their return')

I wonder if this might be a line that the Op takes here in appealing/complaint. I (on my wife's behalf) appealed (to the NHS BSA) for late reimbursements for several years of dental fees she had paid and didn't need to and I won on the basis I quoted to them an official source (Government website) that had implied she would have to pay NHS dental fees and that we relied on that trusted source for information. (Ironically the greater difficulty was getting them to accept my wife had a different name with her dentist because NHS England forms were too short in field length.. and yes I ended up chasing up document changes at NHS England with the same success as I did ESA calculation pages.. zero!)

So potentially helpful if the Op includes the ESA letter and state they believed they were getting income related ESA (highlighting anything supportive in their calculation page) and are happy to pay the dental fees in light of finding out they are not. 'I relied on my official DWP issued ESA award letter and specifically its calculation page which I understood to mean I am getting income related ESA. Apparently over many years this document has caused grave confusion to thousands of claimants and remains uncorrected/unimproved'.

Kim_13

Plenty of claimants have also asked the receptionist/pharmacist for advice and been advised incorrectly. They still get fined. An initial warning and pay for the treatment received/make an arrangement to pay within X days to avoid a fine sounds like a much better system. 

Perhaps example letters of what does and does not qualify should be displayed at the point of claim, then a patient can compare it against the letter that they have and not have to worry about being treated like a criminal and heavily fined for an innocent mistake.