How to talk to patients about fees 

Blog image 12 scaled

Talking to patient about fees can often be an awkward experience. As you can imagine,  there’s plenty of reasons for it, such as the fact that we have grown up with a universal health care system where all health care was “free. On top of that, many years ago health fund remuneration was generous enough to avoid out of pocket costs. 

But times have changed – Medicare and health fund rebates have effectively shrunk over time, insurance costs have increased and demands on doctors for extensive and expensive professional development means that there is a mismatch between reimbursement and fees. 

For anaesthetists, it’s often awkward because when we do have to talk about fees, it’s often right before surgery when we meet them for the first time face-to-face. Even if you no-gap everyone, you’ll still find yourself in this situation every now and then. Having an expert take care of this process beforehand takes a lot of stress out of the process and allows the anaesthetist and patient to focus on the clinical side of things. So always make sure you have a great practice management agent there to take as much care as they can of this touchy subject for you! 

But as we alluded to, you’ll still find yourself every now and then having to talk to patients about fees, and specifically a gap they will have to pay. We’ve compiled a few tips to help smooth out the process. 

1. Understand where they’re coming from

Money is always an emotive subject. When you combine that with patient’s lack of understanding of how health insurance works, it’s no wonder patients are genuinely shocked that they’ll have to pay even more! 

Remember patients pay health insurance premiums, sometimes for many years without benefiting from their insurance. They feel entitled to get what they need for free, as they’ve already paid for it. You can certainly understand this logic! 

2. Explain how it works 

Knowledge is power, right? It’s no different here. 

As a manifestation of the incredibly low transparency of health insurance – and the community’s poor understanding of it – patients will often tell you that they’re “fully covered” without having any appreciation for what that means. It’s a common misconception that all fees are covered and they’re not to blame for that. Patients often misconstrue their level of coverage for “how much they’ll get back” when in fact it’s a determination of what procedures are covered. 

Arguably, this has not been helped by the Federal Government’s requirement to label funds as gold, silver or bronze. Gold cover amplifies the illusion that they are “fully covered”. 

A little bit of education goes a long way, so taking the time out to discuss misconceptions will always empower patients and make them feel in control. 

3. Be matter of fact  

Patients are intelligent human beings who are victims of the opacity of health insurance. When you talk to them, don’t be shy – face it head on, stick to the facts and treat them with respect. Many understand these days that they may have to face a gap; all they need is an honest conversation to understand the situation. Avoid emotional sentiments such as apologising – this will only reinforce the belief that “doctors are greedy” and detract from the exceptional expert care you’re about to provide. 

It’s a conversation best left to after you completed your history and examination – that way they will already appreciate that they have an expert taking care of them. 

4. Frame the conversation 

There are some subtle ways to make the patient feel better about a gap, believe it or not! 

Asking what their health fund is, for example, can give the patient a sense that their fund is making an important financial contribution to their care. It can also make them feel like they are receiving a premium service thanks to their health insurance. 

You can use this to reiterate the benefit of having their health insurance.  

For example, if the gap will be $300, rather than saying “your gap will be $300”, try “your health fund will pay for most of your anaesthetic fee, meaning your out of pocket will be limited to around $300”. 

Or if you going to cap you gap at $500, you could say “I can limit you gap to $500 to ensure that your health fund rebate won’t be affected, and you won’t have to pay the full anaesthetic fee”. 

5. Be prepared to be asked for a discount 

Every now and then, you’ll get asked for a discount from your usual fees. This may come during your usual IFC process, usually with some health fund rhetoric about their fund’s “scheme”, or it may occur during a face-to-face IFC due to an add-on or emergency case. 

If you’re not prepared to give some sort of discount, then have a reason ready to go. A good reason is being equitable to all your patients. So, if you get asked, you might say something like “unfortunately I can’t, as I need to be fair to all my patients to ensure everyone’s fees are as low as I can make them”. 

6. Practice your spiel

Just like exam vivas, practice your IFC spiel. It should roll off your tongue and without needing to think about it when the time arises. If you deliver it confidently, just like your history and examination, it is more likely to be accepted as reasonable. Practice it with family and friends (not your anaesthetic colleagues!) and get feedback. This will help you tweak it so you can deliver it in a manner best suited to your style. 

7. Get it in writing 

This is not a “talking” tip, but a “practice” tip. Having a simple form for acknowledgment of a possible gap can help ensure you get paid. If Solo Practice Management is taking care of your needs, just ask us for our IFC acknowledgement form and print a few copies off for the inevitable! 

So here’s a simple template: 

So looks like everything is good to go for your anaesthetic today. I just need to touch on fees, which health fund are you with? 

Oh that’s good, they’ll pay for most of your anaesthetic fee so your gap will only be around $250 and we can sort out the bulk of it from your fund directly. The rest we can  sort out afterward though, so no need to worry about that now. 

Are there any other questions about your anaesthetic today? 

So in conclusion, remember your patients are intelligent and having been paying insurance premiums for the privilege of private health care, stick to the facts while avoiding emotional messages and frame the conversation to help them see the benefit of their insurance. If you practice it, it will become pretty slick in no time and that awkward feeling will disappear.