It’s normal to give your implant patient a personal treatment guarantee in case of failure. Patients often make purchase decisions based on such guarantees. But there is a problem: they usually aren’t backed by an insurance policy. This is the view of Richard Griggs, MD of Dental Insurance Partnership.
Richard, explain the problem here.
The reality of personal guarantees is that they invariably create a greater liability for the clinician than intended and as they are backed by nothing more than the clinician’s word, in actual fact they are potentially worthless to the patient.
I would not question the integrity and intention of dentists providing a personal treatment guarantee, however if the clinician subsequently moves, retires or dies the guarantee provides no protection to the patient.
Even if the dentist is there to address any future problems, due to the fear of potential litigation they tend to err on the side of caution and in most cases conduct remedial treatments free of charge. Personal treatment guarantees on their own are therefore worthless and don’t benefit either party.
Then why are dentists giving open ended guarantees?
The problem is it has always been the case; what else can a dentist say to a prospective patient who asks, “What happens if it does not work?” If the answer is, “You pay me another £2,500 and we have another try,” I suspect not many patients would be going ahead with the treatment.
Undoubtedly for a lot of patients the guarantee is a major factor in deciding to have an implant. So the real question is: can a dentist provide a personal treatment guarantee when they cannot meet the terms? And at that point, is treatment for the patient being miss-sold?
If you were selling cars on that basis it would be like offering a 10-year blanket guarantee that wasn’t enforceable. A solicitor I know believes the volume of implant cases with some form of guarantee is akin to the PPI scandal, although with PPI at least you’d get something back if you lost your job. Without implant insurance the patient could get nothing.
Dentistry is, as we know, highly regulated, but no other industry is allowed to provide guarantees that are not supportable. You have to have some sympathy for dentists when the GDC advises them to provide written guarantees that just define the clinician’s exposure and do not address the issue: whether spoken or written, these guarantees are not backed and are unsupportable.
What’s the answer?
Replace your guarantee with a clear line that’s backed by an insurance policy which is event specific and time specific. For example, you provide remedial treatment if the implant fails to integrate or loses integration or if the patient suffers an extra-oral trauma in the 12 months following placement of the implant. The protection provides £2.5k per implant to meet remedial treatment costs.
Before the anniversary of the placement you contact the patient, with their consent, and offer them the opportunity to extend their protection for a further 12 months. So there is a clear line where the clinician’s responsibility ends.
But aren’t dentists barred from selling insurance?
Yes, ever since 2005 dentists have been unable to sell or discuss insurance. Our facility enables clinicians to provide their treatment guarantee which is backed by an insurance policy, so you still give your patient a treatment guarantee, but one that is event and time specific — and it is clear that remedial work in the event of failure within those parameters won’t cost them anything.
You paste the terms into your treatment plan so you have in black and white what’s been said to the patient. This is so important because patients often hear what they want to hear, but also with verbal guarantees there is no record and therefore the dentist opens themselves up to the “you said” argument, which they have no way of defending against. I once consulted for a corporate with 40 practices and found there were 17 answers to the question: “What if my implant goes wrong?”
So it’s wrong to say: “If it doesn’t work, I’ll sort it out for you”?
When an implant fails it usually happens in the first six months following placement, so most dentists are looking at the guarantee for implant failure in the initial 12 months following placement. The patient however hears the word guarantee and assumes it covers everything, with no time limit.
Ask a dentist if their guarantee covers a patient who walks into a lamp post and smashes their bridge three years after receiving their implants. Not unreasonably they will not see themselves as having any liability — but if their guarantee states that if the patient has a problem they will fix it, the patient has grounds to not pay for the remedial treatment.
A dentist who provides a guarantee should also provide the patient with the exceptions and parameters of the guarantee. Yet dentists avoid saying the cover is only for 12 months because they want to avoid the next question: “What happens after that?”
So what does happen after 12 months?
We offer the patient the opportunity to take out their own protection for a further 12 months.
How much does the insurance cost the dentist?
The protection is positioned to have a zero cost for the clinician/practice. As a dentist recently summed up the scheme, “So it does not cost me anything and if an implant fails or my patient has an extra-oral trauma anywhere in the world you will pay me for the remedial treatment, my time, lab fees etc?” Yes. “It really is total no brainer.”