That perhaps is one of the statements, I hear from private surgeons more frequently than others.
The following example, however, illustrates that despite the rejection of the fee, examination of how the fee was established confirms there is little the consultant can do about it.
The consultant surgeon concerned only recently applied to be recognised by the private medical insurance. That in itself is not too difficult a process. MHM spoke to the consultant and pointed out fees should be carefully checked when recognition was being arranged. The consultant was extremely well qualified, had held a substantial NHS post for a number of years and his/her specialism was in high demand. The private medical insurance policy was keen to offer recognition. The recognition was thus granted.
MHM was subsequently asked to handle the medical billing side of the practice. In order to do so, we need to know how much the outpatient consultation fees were. Even we can’t charge if we don’t know how much to charge. The medical professional did not, however, know what the consultation fees were. Alarm bells started ringing immediately.
Fees incidentally that they would have agreed to and would have been detailed in the pack supplied to them by the insurance company concerned. So we called the insurance company.
The insurance company, as usual, advised the consultant had agreed to their published fees.
It is always amusing when “fair and reasonable” is quoted. It depends on what the consultant thinks is “fair and reasonable” against what the insurance company thinks is “fair and reasonable”. What happens if the thinking differs between the two? And that is precisely what happened in this example.
The insurance company deemed that £100 was a fair and reasonable fee.
The medical professional deemed that £175 was a fair and reasonable fee.
And thus the consultant instructed MHM to charge a consultation at £175.
MHM pointed out that it would indeed charge £175 as instructed. All that would happen though, is the insurance company would reduce the value of the invoice down to the £100 originally agreed.
And that is precisely 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. Even before I asked the question I knew this was to be true. It mattered even less to the insurance company that a second colleague was paid more than £175 for a consultation. This was so because the second colleague was in a completely different specialism!
Sadly the MHM client had 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. That said 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 (despite the fees being detailed in the recognition pack sent to the client).
Sure enough, the insurance company stood firmly 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. As painful as it is for the MHM client, it really is as simple as that.
Check your fees before you agree to them!