When Should You Call Your Med-Mal Carrier’s Risk Management Team?
Kathleen M. Roman
Dr. Michael has just had an unpleasant telephone conversation with a former patient. Originally, the patient had expressed satisfaction with the results of her treatment. But her account is now six months overdue, and she still owes a substantial amount of money. Dr. Michael’s billing team is pressing the patient to honor the payment schedule she signed and suddenly she’s begun to claim that the results are “horrible” and Dr. Michael should write off the remainder of her bill. The conversation ended with the patient’s comment that she hopes the matter can be resolved “without my having to contact an attorney.”
Dr. Michael understands the threat but isn’t at all certain about how to respond. Should he tell the patient he’ll talk with his lawyer – with his malpractice carrier? Should he tell her he’d like to review her file and get back to her? Should he tell her, “Fine! See you in court!”? Should he ignore her demand and hope she’ll just go away?
The fact is that Dr. Michael doesn’t really know what to do since he’s a pleasant man and a good dentist – and he really doesn’t like to get involved in conflict. Many of his patients have been with him for years and speak highly of him and his staff. He’s had very little experience dealing with unreasonable complaints. And, because he has a clean slate when it comes to lawsuits or dental board complaints, he’s afraid that if he calls his malpractice insurer, his rates will be raised or his insurance will be cancelled.
As is ften the case when we feel rushed to make a decision or take action, this would be a good time for Dr. Michael to step back and give himself some time to think. He might reply to the patient that he’d like to reexamine her file and that he’ll be glad to get back to her within a specific period. This time frame may vary from maybe a couple of days, to about a week. The specific situation will usually dictate how aggressive the doctor should be about setting a follow-up date. Once this information has been communicated to the patient, he should promptly call the risk management department of his malpractice insurance company. Here are several reasons why:
1. Most carriers provide risk management consulting to their insureds; it’s generally considered a part of the insurance service and is usually available to the doctor at no additional charge. There’s a win-win result for both the dentist and the insurance company when a patient’s complaint can be prevented from turning into a lawsuit. For the doctor, it’s much less stressful to work with an expert risk manager, someone who deals with this kind of situation on a daily basis, and who knows the ins and outs of this type of interaction. In addition, the insurer can typically reduce expenses by preventing a lawsuit, as compared to defending one.
2. Dr. Michael might inadvertently make the situation worse if he tries to handle it on his own. His verbal responses to the patient, or his documentation of the discussion with the patient, might muddy the waters. What if, for example, he promised the patient that he’d “take care” of the situation? From his perspective, he’d meant that he’d look into the matter but the patient might opportunistically interpret this statement to mean that he’ll discount her bill, write off the balance due, or possibly even refund her partial payment.
3. Even when the quality of the dental work is perfectly sound, many dentists are so afraid of litigation that they bend over backwards to accommodate demanding patients. Lacking experience in these matters, the doctor may not have the ability to thoroughly evaluate the individual’s motivation. Through listening to the doctor’s story and asking questions, the risk manager may be able to uncover details the doctor may not have considered – and to help develop a response strategy. Too often, the doctor is ready to fling money at the patient in order to close the matter, without thinking through all of the ramifications of such a plan. A savvy risk manager, however, may look at the demand with a dispassionate focus, and the resulting response is likely to be more favorable to the doctor.
4. Knowing “when to fold ‘em” is another benefit to the doctor who has a risk manager helping to manage this type of demand. The risk manager may ask the doctor questions about the patient’s history with the practice, the nature of the treatment plan, whether or not the patient had been cooperative and compliant at some point, or whether the relationship had been dysfunctional right from the start. The risk manager may ask about documentation in the patient’s record of information such as diagnostic discussions, treatment options, patient education, informed consent and patient compliance. The risk manager isn’t thinking only about the clinical integrity of the record, but also evaluating its potential as courtroom evidence. In Dr. Michael’s case, for example, his risk manager will want to know if the patient’s record includes any statements about her earlier satisfaction with the results of the dental treatment. An astute defense attorney will be quick to point out to a jury that the patient had been pleased with the results of Dr. Michael’s work at the time it was completed. “Isn’t it odd,” the attorney will inquire, “that Ms. Patient was perfectly satisfied – until she was asked to pay her bill?”
If the documentation is sound, the doctor may have greater leeway in forestalling the patient’s demands. If, on the other hand, key elements of the record are missing, inadequate, or inaccurate, the risk manager may be able to help the doctor negotiate a reasonable resolution for the smallest possible outlay and obtain a signed release from the patient acknowledging that the matter has been satisfactorily resolved.
In one recent example, a dentist attempted to placate a money-seeking patient by offering her a cash settlement. She accepted and promptly cashed his check. Then she sent him a letter demanding more money because she claimed to have lost additional days of work subsequent to the settlement. At this point, he saw the light and called his risk manager.
By this time, there was little the risk manager could do except help the doctor offer a small additional sum – and require a signed release. Rather than agree to this, however, the patient promptly filed a complaint with the state dental board.
This battle might have been prevented had the doctor called his risk manager after the patient’s first demand. A well-worded reply at that time might have weakened the patient’s resolve. Alternatively, a cash settlement, accompanied by a signed release-from-liability statement, would have prevented any further finagling by the patient.
5. Sometimes doctors report that they’ve been reluctant to contact their carrier’s risk management team out of fear that the issue at hand would lead to an automatic premium increase or non-renewal. Obviously, this article cannot attempt to explain every insurer’s philosophy on this matter but a rigid stance is generally not in either party’s best interests.
Insurers understand that delay in responding to a complaint increases the likelihood that it may become a lawsuit. From this perspective, it is clearly to the advantage of both doctor and insurer to collaborate in a response to the patient’s demands.
Further, risk managers have access to the technical language that will document a closed dispute in a way that can foil a patient’s attempt to reopen the matter. Risk managers are more likely than the practicing dentist to be aware of insurance department mandates, state board requirements and peer review processes. They can steer the doctor through legalistic language and obscure regulations. They can help the doctor strategize responses to patients’ demands and they can help the doctors with documentation and written communications. A good risk manager should know when to get an attorney involved in a dispute and will help the doctor access good legal representation via the insurer’s claims initiation processes.
6. Peace of mind is perhaps the most compelling reason why Dr. Michael should call his risk manager. Often, doctors will end a conversation with their risk manager by saying, “Oh, thank you for your help! I am so glad I called you. I feel so much better now that I’ve had a chance to talk with you.” If for no other reason than it helps to know that an expert is on the doctor’s side, it is a sound idea to make the call.
Rule of Thumb: If the doctor is worried about something that’s going on his or her practice that is related to patient safety and/or satisfaction, then it’s probably better to call the insurer’s risk manager than to lie in bed at night worrying. ■
Kathleen M. Roman is Risk Management Education Leader for Medical Protective, the nation’s oldest professional liability insurance company, founded in 1898. Ms. Roman oversees development of risk management and quality products and services for nearly 80,000 physicians, dentists, and allied healthcare professionals throughout the USA. She is senior editor of her company’s risk management publications and is a popular risk management lecturer for numerous medical, dental, and healthcare organizations. She has authored hundreds of risk management articles. She is a member of the American Dental Association’s ad hoc insurance advisory committee. She can be reached at kathleen.roman@medpro.com
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