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How we check patient exemptions

Published on 03 May 2021

The Patient Claims Team check claims for all exemption categories for dental and ophthalmic services in Scotland.

Our process

Each month we check claims for all exemption categories, including confirming claims with relevant agencies such as the Department for Work & Pensions, HMRC and the NHS Business Services Authority.

If a patient's entitlement has not been confirmed, the following process is applied:

  1. Patient will receive a letter with information on the type, date and cost of the service received and a request that they provide proof of the exemption they have claimed.
  2. If no response is received after four weeks, a Penalty Charge Notice is sent.
  3. If no response is received after another four weeks, a Surcharge Notice is sent.
  4. If there is no response to these notices, a debt management agency will be instructed to recover the claim.

Charges to patients

The statutory charge to the patient is the cost to the patient of the original service.

The penalty charge is five times the original statutory charge up to a maximum of £100.

The surcharge is 50% of the amount of the penalty chage.

The Patient Charge Structure

  • Statutory Charge - the cost to the patient for the service provided as detailed in legislation.
  • Penalty Charge - 5 times the original Statutory Charge (up to a maximum of £100).
  • Surcharge - 50% of the amount of the Penalty Charge.

If you are genuinely entitled to exemption from charges you have nothing to worry about. We are here to ensure that patients entitled to receive exemption charges continue to do so.

How to report fraudulent claims

If you have concerns that other patients are incorrectly claiming exemption from payment, you can use our form to report suspected fraud:

Report suspected fraud to NHSScotland.