A Doctor's Dilemma ... Should You Refund Patient Fees?
Risk Management

A Doctor's Dilemma ... Should You Refund Patient Fees?

More doctors are experiencing patients who request their money back after care is provided. Should you agree to refund patient fees?


Refunding fees is a challenging and evolving concept that must be handled individually. Many factors are at play, and before deciding whether to return a patient’s fee, it can be helpful to consider the following.

Reasons Not to Refund

Many doctors and risk management experts believe it is not wise to refund a patient’s money for a number of reasons:

  • If the patient claims the treatment didn’t work or caused further injury, a refund could be construed as an admission of guilt should the patient decide to pursue a future malpractice claim against you.
  • Not collecting fees may be in violation of third-party insurer agreements and provisions of your professional liability policy.
  • Agreeing to return a patient’s money “just once” could set a precedent that could spiral on indefinitely. For example, if the patient needs further testing, treatment or surgery, then the patient will likely expect you to pay for it. Also, other patients may have similar expectations.
  • Once you begin reimbursing for fees, it can be difficult to start charging again. Many times, the patient will expect free treatment for life.
  • As with most issues in chiropractic, it can be helpful to assess the situation. With layoffs so prevalent these days, it’s increasingly likely the real issue is that the patient no longer has health insurance and is concerned about paying for treatment. If so, it may make sense to give these patients more time to pay or allow them to make partial payments instead of refunding the fee.

If there is no other reason for the patient’s request and it is without merit, you may be able to decline to refund the fee without incurring the wrath of the patient—if you have previously established a good relationship and credibility with the patient.

Reasons to Refund

Returning money to patients may be a new trend, one that’s simply a twist on the common business practice of providing a “money-back guarantee.” For years, this approach has been used in the retail and service industries, and there are some indications it’s taking root in the healthcare profession.

From a practical perspective, agreeing to refund a patient’s fee may prevent an unhappy patient—one who’s more inclined to file a malpractice claim or a complaint with your state board. And it may head off the resulting negative publicity in your community.

For these reasons, you may conclude that agreeing to refund a patient’s fee is potentially less “costly” than the consequences of refusing to do so.

If You Decide to Refund

If you decide to refund the fee, make sure the patient agrees to execute a release before you consent to provide any reimbursement. In essence, the release should state the patient agrees not to pursue a claim against you. A copy of the release should then be placed in the patient’s record along with other documentation on the patient’s care.

Though there is no certainty that a patient will not litigate after signing a release, taking this step usually resolves the matter. Keep in mind that any release should be drafted with the assistance of your practice legal counsel.

Understanding Patients and Involving Staff

There is no right or wrong way to approach patient requests for their money back. However, understanding the problem from the patient’s point of view will go a long way toward reaching an amicable resolution. In addition, remember that patients may discuss billing issues with your staff before you’re even aware of a problem. That’s why it’s essential to have standardized procedures for patient refund requests and to thoroughly train your staff on these protocols.

Regardless of what you decide, it may be advisable to end the doctor/patient relationship if the element of trust has been broken in the doctor/patient relationship. In these instances, make sure to avoid an allegation of abandonment by providing the patient with the names of other doctors to continue their chiropractic care.

If you’d like assistance in responding to a patient’s request to refund fees, contact NCMIC at 800-242-4052. Our professional claim representatives can help you evaluate the situation and the risks involved. Many times, after talking with us, doctors have concluded that their treatment was reasonable and didn’t cause injury. Thus, they were able to stand firm on fees.


The information in the NCMIC Learning Center is offered solely for general information and educational purposes. It is not offered as, nor does it represent, legal or professional advice. Neither does this information constitute a guideline, practice parameter or standard of care. You should not act or rely upon this information without seeking the advice of an attorney familiar with the specific legal requirements of the state(s) in which you practice. If there is a discrepancy between the site and an insurance policy you have with NCMIC, the policy will prevail.