All on x conversions - Who pays?

[Jason D]

We do a lot of these and have had nothing but great success and appreciation from the clients, until yesterday.

We were invited into a case by a restoring doc who was referred by a local implant rep.
We went through the treatment planning process with the implant rep, surgical practice and restoring practice. Showed up for day of conversion, and the surgery went badly, surgeon was not happy with bone quality, did further bone reduction...blah blah blah decided to cover and let the patient heal rather than immediate load. Restoring doc was not present for surgery.

We relined the dentures and went on our way. Now normally we have a substantial but fair price for conversions, but this was a disappointment for everyone and, as a courtesy we decided to forego our normal conversion charge (which is non refundable in the event of a same day debacle normally) and the lost time etc, and just charge for the relines we performed. Told restoring Dr's office manager (who is also treatment coordinator and had been in all the conversations) and he was very grateful, thought we were being very generous about it.

Here's where it got weird: the doctor calls back a few minutes later and says "I didn't hire you to reline those dentures, I'm not paying." Explained that we were NOT charging for the conversion, just the relines, dr remained insistent that she did not even know why we had been at the appointment (despite that being their request from the beginning.) Said if we want to charge someone to charge the surgeon.

SO....

shame on us for not defining the terms beforehand, these cases have become sort of autopilot for us because we do so many of them, and we always bill whichever entity requested the service..and we sort of got brought into this one But my question is: if surgeon and restoring doc are not in the same practice or same person, who normally pays your conversion bill? is it typically restoring doc or surgeon or does it vary from practice to practice?

 

[TheLabGuy]

Depends on where you are at and who initiated the phone call for your services. As you stated though, this should be probably decided before you enter the office where the services are performed. However, as you stated, this is kinda of rare thing (personally never happened to us). Now you are making me go over our in-office consultation/services paperwork. Good post. I will say it's almost always the restoring Docs who gets charged. Can't remember the last time we charged the OS.

 

[JMN]

We do a lot of these and have had nothing but great success and appreciation from the clients, until yesterday.

We were invited into a case by a restoring doc who was referred by a local implant rep.
We went through the treatment planning process with the implant rep, surgical practice and restoring practice. Showed up for day of conversion, and the surgery went badly, surgeon was not happy with bone quality, did further bone reduction...blah blah blah decided to cover and let the patient heal rather than immediate load. Restoring doc was not present for surgery.

We relined the dentures and went on our way. Now normally we have a substantial but fair price for conversions, but this was a disappointment for everyone and, as a courtesy we decided to forego our normal conversion charge (which is non refundable in the event of a same day debacle normally) and the lost time etc, and just charge for the relines we performed. Told restoring Dr's office manager (who is also treatment coordinator and had been in all the conversations) and he was very grateful, thought we were being very generous about it.

Here's where it got weird: the doctor calls back a few minutes later and says "I didn't hire you to reline those dentures, I'm not paying." Explained that we were NOT charging for the conversion, just the relines, dr remained insistent that she did not even know why we had been at the appointment (despite that being their request from the beginning.) Said if we want to charge someone to charge the surgeon.

SO....

shame on us for not defining the terms beforehand, these cases have become sort of autopilot for us because we do so many of them, and we always bill whichever entity requested the service..and we sort of got brought into this one But my question is: if surgeon and restoring doc are not in the same practice or same person, who normally pays your conversion bill? is it typically restoring doc or surgeon or does it vary from practice to practice?

Whoever signs the prescription is ultimately responsible. No RX? Bill who told you to reline it. You have to have something signed somewhere about this case.

Just another dentist getting involved in something they have no clue about and refusing to learn anything while being taught everything.
She probably had no idea your presence was required for the process, even if told directly, and assumed many other things.

 

[Sda36]

Whoever signs the prescription is ultimately responsible. No RX? Bill who told you to reline it. You have to have something signed somewhere about this case.

Just another dentist getting involved in something they have no clue about and refusing to learn anything while being taught everything.
She probably had no idea your presence was required for the process, even if told directly, and assumed many other things.

Well said [emoji5][emoji5]

Sent from my LG-H873 using Tapatalk

 

[lcmlabforum]

The patient being the "She" or the office manager?
There is a saying I like - and it applies to goodwill and gratefulness.
When you borrow and return, the next time you are welcome.
When you borrow and do not return, you can forget about it the next time.
I am so sorry for being treated so badly.
Like the others say, it would be best to have some document up front next time,
and certainly someone to sign an Rx before initiating any work, either OMFS or
restorative. Who ever signed that needs to then get a signed consent from the
patient to work on an existing prosthesis so that you don't get blamed for any
adverse outcome.
Thanks for sharing,
LCM

 

[JMN]

The patient being the "She" or the office manager?
There is a saying I like - and it applies to goodwill and gratefulness.
When you borrow and return, the next time you are welcome.
When you borrow and do not return, you can forget about it the next time.
I am so sorry for being treated so badly.
Like the others say, it would be best to have some document up front next time,
and certainly someone to sign an Rx before initiating any work, either OMFS or
restorative. Who ever signed that needs to then get a signed consent from the
patient to work on an existing prosthesis so that you don't get blamed for any
adverse outcome.
Thanks for sharing,
LCM

That's an interesting idea, never thought of the patient explicitly permitting the modification to something they own. Quite wise.

 

[lcmlabforum]

Have to, patient may not accept that after surgery, a removable prosthesis does not fit as well as
before no matter how much you try to explain after the fact, because in the mind, it could be
perceived as lack of skills or experience even though you did the best work. Esp. since surgery
already did not go as plan . . .
LCM

 

[TheLabGuy]

I don't think I would get hung up on having a Rx (however, it would solve the current issue). Why I say that is, if you're an in-house lab, most don't have the formal prescriptions like we do. I'm not sure state laws require to have a signed prescription if you're an in-house lab because your under the 'direct' direction of the Licensed Dentist. Makes for an interesting question though.

 

[Jason D]

I agree about covering bases ahead of time for everyone’s benefit. We have a formal protocol that takes care of this normally.

(It’s actually one of our favorite creations, an online project management/ collaboration tool that logs all relevant details and ensures various things happen like confirmation calls and reviewing conversion prosthetics prior to the appointment, confirms who is ordering parts and changes to the treatment plan so the whole team stays on the same page)

Unfortunately we were brought in from the side on this one so our normal protocol wasn’t fully used. Lesson learned - when your system works, don’t abandon it for someone else’s convenience

I do not believe in arguing with clients, I either help them and expect to be compensated for it appropriately or I help them find a more suitable partner. I find most problems are not because the other person is a jerk, but that their expectations (reasonable or otherwise) were not met, and I try to work on understanding and addressing those expectations so we can all succeed.

The resolution we chose:

We apologized to the restoring office for the misunderstanding and told them there would be no charge in consideration of everyone’s frustration over the case.

We told the implant rep about the result, who offered to comp us some components out of respect for how we handled the situation. (The offer was for a lot more than what we lost on a couple complimentary relives). We declined but thanked him for the offer. He also told us about a study club he would like us to participate in, said he likes our way of doing business.

The surgeon was also impressed, said they have a lot more conversions coming up and that we are the most professional service oriented lab they have dealt with yet. Future looks good with new surgical client and a new study club.

I’ll give up a couple relines tomorrow and see what that brings

 

[droberts]

No issues here so far. All discussed before the surgery happens. Most if the time, the restoring doctor is invoiced.
Only once so far, have I sent the invoice to the OS for the temp / conversion & the final restoration. Also to add.
If perhaps it cannot be converted that day, the fee is still the same.

 

[Flipperlady]

We do a lot of these and have had nothing but great success and appreciation from the clients, until yesterday.

We were invited into a case by a restoring doc who was referred by a local implant rep.
We went through the treatment planning process with the implant rep, surgical practice and restoring practice. Showed up for day of conversion, and the surgery went badly, surgeon was not happy with bone quality, did further bone reduction...blah blah blah decided to cover and let the patient heal rather than immediate load. Restoring doc was not present for surgery.

We relined the dentures and went on our way. Now normally we have a substantial but fair price for conversions, but this was a disappointment for everyone and, as a courtesy we decided to forego our normal conversion charge (which is non refundable in the event of a same day debacle normally) and the lost time etc, and just charge for the relines we performed. Told restoring Dr's office manager (who is also treatment coordinator and had been in all the conversations) and he was very grateful, thought we were being very generous about it.

Here's where it got weird: the doctor calls back a few minutes later and says "I didn't hire you to reline those dentures, I'm not paying." Explained that we were NOT charging for the conversion, just the relines, dr remained insistent that she did not even know why we had been at the appointment (despite that being their request from the beginning.) Said if we want to charge someone to charge the surgeon.

SO....

shame on us for not defining the terms beforehand, these cases have become sort of autopilot for us because we do so many of them, and we always bill whichever entity requested the service..and we sort of got brought into this one But my question is: if surgeon and restoring doc are not in the same practice or same person, who normally pays your conversion bill? is it typically restoring doc or surgeon or does it vary from practice to practice?

The dentist and the surgeon have a relationship, both benefit each other with referrals. You have a really cheap dentist/client to argue over which dentist will pay for reline considering what he is probably charging for the denture. i would add an extra line in your legal fine print to add that you are not responsible for dentist subcontracting out your work and unless worked out in advance that original signer of prescription will be charged for any unforeseen circumstances.

 

[Bryce Hiller]

I agree about covering bases ahead of time for everyone’s benefit. We have a formal protocol that takes care of this normally.

(It’s actually one of our favorite creations, an online project management/ collaboration tool that logs all relevant details and ensures various things happen like confirmation calls and reviewing conversion prosthetics prior to the appointment, confirms who is ordering parts and changes to the treatment plan so the whole team stays on the same page)

Unfortunately we were brought in from the side on this one so our normal protocol wasn’t fully used. Lesson learned - when your system works, don’t abandon it for someone else’s convenience

I do not believe in arguing with clients, I either help them and expect to be compensated for it appropriately or I help them find a more suitable partner. I find most problems are not because the other person is a jerk, but that their expectations (reasonable or otherwise) were not met, and I try to work on understanding and addressing those expectations so we can all succeed.

The resolution we chose:

We apologized to the restoring office for the misunderstanding and told them there would be no charge in consideration of everyone’s frustration over the case.

We told the implant rep about the result, who offered to comp us some components out of respect for how we handled the situation. (The offer was for a lot more than what we lost on a couple complimentary relives). We declined but thanked him for the offer. He also told us about a study club he would like us to participate in, said he likes our way of doing business.

The surgeon was also impressed, said they have a lot more conversions coming up and that we are the most professional service oriented lab they have dealt with yet. Future looks good with new surgical client and a new study club.

I’ll give up a couple relines tomorrow and see what that brings

I think you handled this situation with much wisdom. We've had situations similarly to these. My experience is that if you are willing to set your pride aside and provide outstanding customer service even when you don't have to, it typically benefits you in the long run. Hope this results in a wonderful new account for you!

 

[lcmlabforum]

As long as this does not become a precedent for anyone to take advantage of you.
"We apologized to the restoring office for the misunderstanding and told them there would be no charge in consideration of everyone’s frustration over the case."
Everyone's frustration is no fault to the lab.
Just my FWIW perspective.
LCM

 

[PCDL]

Tell em to send the dentures back and all is square, otherwise, Pay Up! Cheap asses. I have no patience for the petty nonsense. That doc wouldnt be getting a second shot with me!

Whoops! Just saw the date on this one. My bad...