Resolving Disputes or Complaints with a Dentist
Even in the best dentist-patient relationship, a problem may occur. First, discuss any concerns you have with your dentist. Many times this will help clear up the matter. If you are still not pleased, the MDA has an established dispute resolution system called Peer Review to help resolve the occasional disagreement about dental treatment.
Peer review is a valuable service that offers a way to resolve differences between a dentist and patient, or between a dentist and third party, such as an insurance carrier. MDA members act as volunteers to attempt to mediate matters pertaining appropriateness and quality of care, and negotiate a resolution that is acceptable to the involved parties without either party becoming involved in litigation.
The MDA central office manages the peer review process and all cases must be initiated through the central office. When a patient initially files a complaint, the case is assigned to a local peer review chairperson and local Peer Review Committee.
The first step in peer review is mediation. This is an important step because if properly done it can reestablish good communication and trust between the patient and dentist. At this step the chair appoints one member of the local peer review committee to act as the mediator. If mediation is not successful, the full Peer Review Committee reviews the case and interviews each party separately. When the Committee reaches a final decision the parties are notified.
The Peer Review Committee consists of MDA member dentists who volunteer their time and expertise to review cases and assist patients. They may meet to discuss the case and may examine clinical records, talk to the dentist and patient and, when indicated, arrange for a clinical examination.
If you determine your case is a matter appropriate for peer review, you may download the Mediation Request Form (PDF), complete and return to the MDA to begin the peer review process. For further information regarding the Peer Review process, call 1-800-257-4988 or 1-406-443-2061.
Matters for Peer Review:
- Appropriateness of Care: The Peer Review Committee will determine the professional acceptability of planned or completed diagnostic evaluations or treatments. In other words, did the dentist provide appropriate treatment for the condition that existed?
- Quality of Care: The Peer Review Committee will evaluate whether the treatment provided met the standards that generally prevail within the professional community by those who routinely perform the treatment in question. In other words, was the treatment performed by the dentist done correctly?
- Fees: The Peer Review Committee will determine whether the fee charged is the dentist's usual fee for a given treatment or procedure.
- Member Dentist: The dentist whom the complaint is against must be a MDA member (non-member dentists can participate but at a cost equal to one year's dues payment).
Matters not for Peer Review:
- Any complaint that doesn't concern the appropriateness or quality of care will not be accepted for review.
- If the case involves a fee or billing dispute, the case will not be accepted for peer review except as stated above.
- Complaints of poor customer service, practice management, or complaints concerning a staff member's behavior will not be accepted for peer review.
- The treatment rendered must be current.
- If the patient has filed a civil lawsuit regarding the claim, Peer Review will not accept the case.
The Review Process
- A written request for review – but not specific relief – is submitted to the state or local dental society. The request should include all necessary and appropriate documentation that would help to clarify or support the circumstances.
- The request is reviewed for completeness and referred to the appropriate peer review committee.
- The chairman of the peer review committee reviews the request and appoints one member of the committee to attempt to mediate the problem.
- The mediator contacts all parties and attempts to reconcile the problem. A clinical examination is not conducted during the process of mediation.
- If thee problem is successfully mediated, a written report is submitted to the committee chairman and the case is closed.
- If mediation is not successful and further action is necessary, the chairman is advised and a committee of at least three members is appointed.
- The committee may meet to discuss the case, and may examine clinical records, talk to the patient and the dentist and, if necessary, arrange for a clinical examination.
- The committee concludes its review and all parties are notified of the decision and recommendations in writing.
- If any of the parties is not satisfied with the decision and can show just cause for an appeal, the case can be appealed to the appropriate peer review appellate body.
- The decision of the appellate body is final within the peer review context.
- All information regarding a particular case is kept strictly confidential.
Peer review provides an impartial, easily accessible and generally expedient means for resolving misunderstandings regarding dental treatment. It exists for the benefit of the patient and the dentist, and for the third party. Peer review is not a court of law. It is generally a voluntary process that relies on the good faith between a dentist and a patient and their mutual interest in good dental health.
Montana Dental Association
38 South Last Chance Gulch, Ste. 205
P.O. Box 1154
Helena, Montana 59624
800-257-4988 (In Montana only)
406-443-2061 (in the Helena area)