The ‘refunding of fees’ era – how and when to do it

7^th April 2025

Over the last five years there has been an increase in the number of refunds that have been given by surgeons to their patients. This is particularly the case in plastic surgery due to the nature of the work that is caried out.

What is a refund of fees?

In the majority of situations, a refund of fees is agreed in response to a complaint that has been made by a patient. It may be that the result is not what they were expecting, perhaps their body has reacted in an unexpected way, or maybe there has been a complication which has affected the result. In some situations, a complaint is made immediately, and in other situations the complaint is made once all other options, such as revision surgery or other treatments, have been exhausted. Not all complaints are aggressive, and sometimes a patient may not even directly request a refund.

When a surgeon makes an offer for a refund of fees, in the majority of cases, they are only referring to their surgical fee. Not the hospital fee. The purpose of refunding a patient is to try to resolve a complaint quickly and stop it escalating further. If the patient receives the refund, it either puts them back to the financial position prior to surgery, or provides funds they can use towards further revision surgery.

When and how do you make the refund?

Deciding whether or not to offer your patient a refund of your fee is difficult. It is important to find the balance between doing what is right for the patient, versus ease to resolve the situation. It is a quick and simple solution to make the refund but in a lot of situations it is not actually necessary.

Does the patient actually need a refund of the fee?

Are they having further surgery at their expense?

What is the result like, is this a case of managing the patient’s expectations, or does the result require revision?

Is there another option, could they have a second opinion?

Are they threatening, or are they merely dissatisfied?

These are the sorts of questions you need to think about when deciding on how to proceed.

When making a refund of fees, it is important that the process is documented well. You will normally need to compile a letter of response to the complaint. This will need to include a chronology of events and answer any specific questions and concerns that the patient has raised. In this letter is it important that express that the refund is made a gesture of goodwill. As part of the offer, the patient will be asked to sign a ‘release form’ which will contain some formal wording to protect you going forward when offering the refund.

Why has there been such an increase in requests?

There has been an increase in complaints over the last 5 years. There are various reasons for this, but a key reason for this increase is because patients are becoming more aware that refunds are being offered – it becomes self-fulfilling. Websites, plastic surgery forums, blogs and all other forms of online interaction has advertised that this option of resolution is being offered, and this becomes appealing for a lot of people. It is also much easier for you, as a surgeon, to pay the patient rather than continue a lengthy complaints process, a risk of litigation, or even a risk of online negative feedback.

Conclusion

To conclude, there has clearly been an increase in the amount of refunds that are being made by plastic surgeons. This is a financial burden for you and is something that needs to be monitored. In some situations, to prevent escalation, a refund of fees is the most appropriate resolution, but it is important to keep an eye on how many refunds are being made and to question whether the refund is justified or not. Each situation will be different, and it is important that you call the helpline and notify a situation that may give rise to a refund, we can assist you with drafting a letter and ensure you are responding correctly to protect your interests.

Emily Borhan

PRASIS Medicolegal Advisor

April 2025