Patient Mediation

Peer Review and Quality Assurance

 

 

What is Peer Review?

Peer Review is an option to settle complaints about dental treatment performed by NYSDA member dentists. It is a form of common-law, contractual arbitration and provides confidential, impartial and timely mechanism to resolve disputes about appropriateness of treatment and the quality of care rendered by New York State Dental Association (NYSDA) member dentists. There is no cost for this service.

Concerns About Your Care?

When you choose a NYSDA member, your dentist is committed to providing the highest quality dental treatment possible. If you have concern about the care provided to you, the first thing you should do is go back to your dentist. Often discomfort after treatment can be fixed with an adjustment or additional care.

NYSDA Peer Review Committee resolve disputes about the quality of care and appropriateness of treatment rendered by its member dentists. They review and mediate disputes among patients and dentists.

Fee Dispute?

  • Fee disputes are private matters between doctors and patients. Dentists establish fees individually and independently of each other. Peer Review addresses questions of "usual or customary fees" only in cases involving dental benefit companies.
  • Fee disputes must be settled privately between the dentist and patient, or by the courts, and can't be resolved by NYSDA, Third District or any other public agency.

All NYSDA members are required to participate in Peer Review and to abide by the decisions of Peer Review committees

  • Peer Review is a dispute resolution process. NYSDA offers this as an alternative for patients to resolve complaints about treatment quality. Peer Review cannot hear complaints that are before (or have already been resolved through) the courts or the New York State Education Department.
  • There is no charge for Peer Review
  • Peer Review is objective and confidential
  • Peer Review can only evaluate treatment completed within the past two and a half years.
  • When Peer Review funds treatment unacceptable, the dentist is directed to refund only the fees received for that treatment. Peer Review does not make punitive awards
  • When treatment is found to be appropriate and the care provided acceptable, all outstanding patient fees are remitted to the dentist

How Does It Work?

  • Both the patient and the dentist submit the Agreement to Submit to Peer Review.
  • A mediator will contact them to try to resolve the dispute
  • If mediation is unsuccessful the Peer Review Committee conducts a hearing. The hearing committee is made up of three volunteer dentists. These dentists examine all patient records and other evidence submitted. They interview the dentist and the patient. They individually examine the patient's mouth
  • A letter of determination is send to both the patient and dentist upon completion of either the mediation or hearing explaining the committee's findings.

How Do I Find Out More?

  • Contact the Third District Dental Society if your dentist practices in Albany, Rensselaer, Columbia, Greene, Ulster or Sullivan county at 518-782-1428
  • Other counties are listed on the NYSDA web site.

Download the Guide To Peer Review

 

 

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