Are You Making Guarantees?

Consider an ongoing review of your materials and your website to see if you are stating or implying a warranty of care. Doctors who convey, even inadvertently, that a certain outcome is guaranteed may be obligated to issue patient refunds.

Should You Refund Patient Fees?


posted by Mike Whitmer on Tuesday, August 22, 2017

Many N.D.s have patients who request their money back after care is provided. Should you agree to refund patient fees?

Refunding fees is a challenging and evolving concept that must be handled individually. Before deciding whether to return a patient’s fee, it can be helpful to keep in mind the following considerations.

Reasons Not to Refund

Many doctors and risk management experts believe it is not wise to refund a patient’s money for a number of reasons:

  • If the patient claims the treatment didn’t work or caused further injury, a refund could be construed as an admission of guilt should the patient decide to pursue a future malpractice claim against you.
  • Not collecting fees may be in violation of third-party insurer agreements and provisions of your malpractice insurance policy.
  • Agreeing to return a patient’s money “just once” could set a precedent that could spiral on indefinitely. For example, if the patient needs further testing, treatment or surgery, then the patient will likely expect you to pay for it. Also, other patients may have similar expectations.
  • Once you begin reimbursing for fees, it can be difficult to start charging again. Many times, the patient will expect free treatment for life.
  • It can be helpful to assess the situation. The real issue could be that the patient no longer has health insurance and is concerned about paying for treatment. If so, it may make sense to give these patients more time to pay or allow them to make partial payments.

If there is no other reason for the patient’s request and it is without merit, you may be able to decline to refund the fee without incurring patient anger—if you have previously established a good relationship and credibility with the patient.

Reasons to Refund

Returning money to patients may be a twist on the common business practice of providing a “money-back guarantee.”  Additionally, agreeing to refund a patient’s fee may avoid having an unhappy patient. A patient who is unhappy is more inclined to file a malpractice claim or a board complaint and share negative comments about you publicly.

For these reasons, refunding a patient’s fee sometimes has fewer downsides than refusing to do so.

If You Decide to Refund

If you decide to refund the fee, make sure the patient agrees to execute a release before you consent to provide any reimbursement.

In essence, the release should state the patient agrees not to pursue a claim against you. (Make sure to seek the input of your practice legal counsel in the development of this document.) A copy of the release should then be placed in the patient’s record, along with other patient care documentation.

Though there is no certainty that a patient will not litigate after signing a release, taking this step usually resolves the matter.

Understanding Patients and Involving Staff

There is no right or wrong way to approach patient requests for their money back. However, understanding the problem from the patient’s point of view will go a long way toward reaching an amicable resolution. In addition, remember that patients may discuss billing issues with your staff before you’re even aware of a problem. That’s why it’s essential to have standardized procedures for patient refund requests and to thoroughly train your staff on these protocols.

Regardless of what you decide, it may be advisable to end the doctor/patient relationship if the element of trust has been broken in the doctor/patient relationship. In these instances, make sure to avoid an allegation of abandonment by providing the patient with the names of other doctors to continue their naturopathic care.

If you’d like assistance in responding to a patient’s request to refund fees, contact NCMIC at 800-952-9935. Our professional claim representatives can help you evaluate the situation and the risks involved. Many times, after talking with us, doctors have concluded that their treatment was reasonable and didn’t cause injury. Thus, they were able to stand firm on fees.

  1. business
  2. claims
  3. naturopathic
  4. risk management

About The Author

Mike Whitmer

Mike Whitmer is assistant vice president of insurance programs at NCMIC. With over 25 years' experience in insurance and finance, Mike has in-depth information to share with NDs. He is responsible for NCMIC's corporate relations team and directing risk management education efforts for doc ... read more

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