Who really sets your fees?
Most consultants, and certainly when they first start a private practice consider how best they can set their fees.
In reality, however, it is not the consultant who sets his or her own fees.
It is the patient’s insurance company.
Fee setting should be viewed from two areas:
Insurance Company Fees
Self Funding Patients
Insurance Company Fees.
Consultation fees, for example, will be agreed at the point of recognition by the medical insurance company.
Clearly, if you have 20 years post qualification experience and are one of the few consultants within your geographic area in a particular specialism, then you can command a higher fee.
In reality, most likely you not be in such a position. You will be offered consultation fees at a level set by the insurance company you are dealing with. In return, the insurance company will refer patients to you.
Surgical fees, if anything, are the easier one to deal with.
The insurance company with whom your patient is insured will always set surgical fees.
You may feel the fee is too low and therefore charge more.
Almost certainly your invoice WILL be rejected or at the very least shortfalled to the patient.
Keep sending invoices in for fees greater than that allowed by a particular insurance company and you run the risk of being de-recognized.
Self- Funding Patients
In the case of self-funders, however, there is nothing to stop you charging any fee you like.
Save of course if there are other consultants in your area then the fee levels they charge will influence that which you yourself charge.
Whether it is right or wrong for insurance companies to hold such power over the setting of surgical fees is for another article.
I have very firm views on it but at this point, the stark reality is that the insurance companies do hold such power.