The Bermuda Dental Association has established a Peer Review system. Its purpose is to resolve disputes that may arise in the delivery of dental services to the public; in particular, disputes regarding the quality and/or appropriateness of dental treatment, utilization (problems related to dental insurance benefits when treatment is questioned), and/or potentially irregular billing practices.
Although the peer review system can satisfactorily resolve the majority of complaints received, there are limitations that may make a complaint inappropriate for the system The following types of complaints are NOT within the purview of peer review system:
- Cases which do not meet "time" criteria
Excessive passage of time alters clinical conditions. Therefore, a complaint will not be reviewed if it is received more than three years from the date treatment was completed, or more than one year from the date the complainant became aware of the problem.
- Cases in litigation
The peer review system is designed to resolve patient/dentist disputes. Consequently, no matter will be accepted for peer review if either party has initiated litigation concerning any aspect of the dental services which might otherwise be directed to review.
- Cases petitioning for monetary awards
Requests for reimbursement for time lost from work, pain and suffering, mileage and medical expenses cannot be accepted in the peer review system as it is not a punitive system, but rather an evaluative one.
- Cases not related to treatment
Questions concerning matters other than dental treatment (e.g., a dentist’s attitude, communications problems, etc.) are outside the purview of the peer review system.
- Cases related to appropriateness of fees
Peer review will not review cases that involve fee disputes or the appropriateness of fees.
Peer Review Procedures
A peer review committee, comprised of BDA member-dentist volunteers, evaluates all available evidence pertaining to each dispute and follows specific procedures (listed below) to make a fair and impartial determination. The parties involved are then notified of a committee’s decision by a letter of resolution. If any party to a review can factually demonstrate that a procedural error may have occurred, or that the decision was not based on available facts, an appeal to the BDA may be requested. This appeal must be mailed within 30 days of the date the letter of resolution. Any decision of an appeals panel is final and binding.
The patient must sign a Record Release and agreement form prior to review.
Initially a mediator is assigned to attempt a mutually acceptable resolution of the matter without more formal proceedings. In mediation, the patient is not examined nor is any conclusion reached as to the validity of the complaint. If mediation is unsuccessful, a Peer Review committee of three dentists reviews the case.
Before the Peer Review Committee begins its review, each party must sign a consent form, indicating his/her willingness to cooperate with the committee and accept its decision as binding and enforceable under Bermuda law. By signing the consent form, both parties waive their rights to have the dispute settled in a court of law. Each party receives a copy of the others signed consent form.
- The review may involve examination of the patient.
- The patient will be given an opportunity to present any additional comments, usually at the time of the patient examination.
- The dentist will be invited to meet with the review committee if he/she chooses.
- All other involved parties (second treating dentists, insuring entities) will be contacted for whatever additional evidence is available.
- Attorneys may not represent either party in the peer review process.
- The peer review committee will evaluate all evidence available (patient examination, radiographs, statements from other treating dentists, etc.), and make a final determination. This will be communicated to all involved parties in the form of a letter of resolution, which will provide adequate rationale for the decision.
- All involved parties will be provided Appeal Criteria at the time the letter of resolution is provided.
- When the committee finds in favor of the patient, the dentist may be directed to adjust or redo the treatment, provided that the patient is willing to return. If not, the committee may direct the dentist to return all or a portion of the fees paid for the treatment in question. In no event will the amount of refund be greater than the total fees paid.
- All monetary awards are handled through the BDA. In cases where monies are to be returned to the patient, the BDA will obtain a signed release form, which will be subsequently sent to the dentist.
This summary is intended to provide general information regarding the Peer Review System and its procedures but is not all-inclusive. Inquiries may be directed to:
The Bermuda Dental Association
P.O. Box HM 3059
Hamilton HMNX
