When discussing medical invoicing many private medical professionals say to me “I want more of a consultation than that” It is one of the statements I hear more frequently than others.
The following example however illustrates how a consultation fee is established confirms there is little the consultant can do about it once the fee is set.
The medical professional concerned only recently applied to be recognised by the private medical insurance. That is not too difficult a process in itself. MHM spoke to the consultant. When recognition is being applied for , we pointed out fees should be checked carefully. The consultant was extremely well qualified. She had held a substantial NHS post for a number of years. Her specialism was in high demand. The private medical insurance policy was keen to offer her recognition. They wanted to refer patients to the consultant also. The recognition was thus granted.
MHM were subsequently asked to handle the medical billing side of her practice. To do so we needed to know how much her outpatient consultation fees were. The consultant did not however know what the consultation fees were. Alarm bells started ringing immediately.
Consultation fees would have agreed and would have been detailed to the consultant by the insurance company concerned as we had said. So we called the insurance company and quoted the newly acquired provider number.
The insurance company, per normal, were keen to point put the consultant had agreed to adhere to their published fees.
It is always amusing when “fair and reasonable” is quoted to me because it depends on what the consultant thinks is “fair and reasonable” against what the insurance company think is “fair and reasonable”.
What happens if the thinking differs between the two parties concerned? And that is precisely what happened in this example.
The insurance company deemed that £100 was a fair and reasonable fee for a consultation.
The medical professional deemed that £175 was a fair and reasonable fee.
And thus the consultant instructed MHM to charge a consultation at £175.
And that is what happened.
Despite the medical professional objecting strongly to a consultation fee of £100 and insisting a “fair and reasonable” fee was £175, the invoices were reduced in value.
It mattered little to the insurance company that the MHM client had colleagues who were both charging and getting paid £175. Before I asked the question I knew this was to be true. It was true because the colleague concerned had many years more experience. It mattered even less to the insurance company that a second colleague was paid even more than £175 for a consultation. This was because the second colleague was in a completely different specialism!
MHM’s client had, sadly, based their practice business plan on a consultation fee of £175. They had done so because they had asked colleagues how much they were paid. They had then assumed such fees would equally apply to them.
MHM, per normal, had no issue calling the insurance company concerned and arguing the case on behalf of the medical professional. It was an argument that was never going to be won. The simple reason remained that at the point of recognition the MHM client had accepted the fees. It mattered little the client hadn’t fully understood what was being offered.
Sure enough the insurance company stood firm behind its agreement with the consultant.
The moral of this sorry tale is best summed up by the above heading.
I’m not suggesting you shouldn’t challenge fees for consultations or indeed a surgical episode. But don’t put yourself on the back foot by accepting fees and then challenging them afterwards.
As painful as it is for the MHM client, it really is as simple as that.
Check your fees before you agree to them!