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Medical Justice

Making healthcare safe for doctors


Your Patient Bolts in the Middle of a Treatment Plan. Now What?

11/18/16 4:00 PM

Not all medical and dental procedures are completed in one setting. They are staged.

A common example is a patient needs new teeth. Impressions are taken. Temporaries are placed. The lab fashions the new implants. They are placed down the road.

Patients often pay upfront for the bundled procedures. And the work is front-loaded. The effort expended in the final step is typically the least labor intensive.

What happens if a patient “loses the love” in the middle of the process? They want to go somewhere else. AND they want you to pay for them to start over.

Once you start a treatment plan, you typically need to finish it. Or make sure the patient has an agreed-upon plan to finish the treatment elsewhere. Otherwise, the patient can make a case to the Board they were “abandoned.”

So, how to resolve the impasse?

The patient wants to leave the practice but wants money to leave – to start over elsewhere.

Here’s how one practice handled it  – in my estimation – adeptly.

Dear XXX:

I received a call you want to finish your treatment elsewhere. To recap, you prepaid for a treatment plan. Extensive work was performed over a number of patient visits. You decided you wanted to receive follow-up care from another practitioner. We think it makes the most sense to complete your treatment with us. And we remain ready, willing, and able to do so. But ultimately, that decision is your call, and we respect your right to do so.

You have a credit remaining on our account for $XXX. This represents a sum that would have been allocated to complete the agreed-upon treatment plan. This amount will be sent to you shortly.

As for accounting, the following catalogs what was performed:

And the following itemizes what likely remains to be performed.

While your credit would indeed cover work to finish the treatment plan in our office, I cannot guarantee that amount will allow you (to accommodate your choice) to complete the treatment plan in another practitioner’s office.

I wish you well.

A final note: If a patient prepays for a bundle of procedures and not all of those procedures are performed, you do have an obligation to refund the money for what was not done. Every state treats this differently. But, patients who believe that funds were kept can file a complaint with the state Attorney General. A final, final note: This is different circumstance than a patient who puts a deposit on a scheduled procedure and slot is reserved and supplies ordered. And the patient does not cancel the procedure in a reasonable agreed-upon time frame. In that circumstance, some things were done. A reserved slot kept other patients from accessing that same slot on the surgery schedule. Supplies may have been ordered that cannot be returned or reused.

A practice never wants to be in the cross hairs for a charge of patient abandonment. Handling financial matters properly when a patient wants to go elsewhere will prevent such a charge from being leveled.

What do you think?

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Posted by Medical Justice | in Blog | 5 Comments »
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Joe Horton
Joe Horton

Looks like the letter would appeal to a reasonable patient. The conflicts will arise when a patient isn’t reasonable, as in: she wants to start the whole process over with another doctor and wants all her money back so she can do that. That’s when things will get…interesting.


Patients do this all the time. They do not typically do this when they have prepaid for care. I would add to the letter something to the effect of an apology if the reason that the patient is seeking care elsewhere is because of not meeting any performance goals that the patient expected of you or your office. I would state that if I or any of my staff did not meet or exceed your expectations then I humbly apologize. Those apologies count for a lot even if you did nothing wrong. You could have a receptionist who is rude… Read more »


Excellent template!

Raymond Kimsey
Raymond Kimsey

Last year I had a new patient come to me with the above situation where she was near the end of her treatment but wasn’t satisfied with the aesthetics. Since the treating dentist was so close to completion I encouraged her to let him finish then we could better discuss her desires prior to me starting the case. Much better to have a definitive start with known dislikes and desires than to start without a fixed point. At the end of treatment she was completely happy and didn’t cause any excessive grief for the previous dentist.


I feel the template is great! I am appreciative of it and feel it is a valuable tool. Although all situations are different, there has to be a meeting. The patient has to be reasonable and the doctor as well. the template is a template and should be modified accordingly.