Ensure patients know your terms

With the Competition and Markets Authority pushing for greater transparency over consultants’ fees, and hospitals publishing more information about specialists who use their facilities, Garry Chapman (right) says it’s time to ‘get ahead of the curve’

As regular readers of Independent Practitioner Today will be aware, the Private Healthcare Information Network (PHIN) has now been appointed by the Competition and Markets Authority (CMA) to run a consumer-based website providing data on both hospitals and consultants.
This will enable patients to have more information and allow many of them to make their own choices about treatment.
At the same time, the CMA has been pushing for greater transparency in fees by consultants, while hospitals are publishing more information about them.
So, while all these changes are taking place in the market, we would recommend getting ahead of the curve by implementing a process for your own data on both pricing and performance.
For pricing in a commercial environment, the ‘terms and conditions’ describe how the company will conduct its business with its clients and typically form part of a commercial contract. In private healthcare, and particularly for consultants, we are talking about the patient registration form.
It has always been our advice for each practice to use a patient registration form to notify patients about how they charge. This, in turn, leads to fewer fee problems with them later on.
Where possible, we recommend that a practice has a set of words which describe how the transaction between the patient and the practice will work in relation to its pricing and the payment of any treatment provided.
In light of the CMA report, the practice may also want to consider having the consultant’s biography as part of this document, including any statistics on performance and any work that they have published.
This wording can be printed on the headed paper of the practice and handed to the patient or it can be emailed to new patients when they book an initial consultation.

Make the patient aware
The important thing is that the patient is made aware of the information before treatment starts in order to avoid any ambiguity.
In our experience, when a patient has private health insurance, many of them immediately think that all the costs of the treatment are covered, when, in reality, there is in most cases a cost element that the patient has to pay.
The vast majority of patients have health insurance through their companies, so most of them are unaware of the small print of their own policies, which typically leave them with a shortfall.
This can be for many reasons and the main ones are:

  • They could have an excess on the insurance policy for the first part of the treatment;
  • They could have exceeded the benefit limit of the policy;
  • They could have a policy which is called co-share, where they have to pay a percentage of each invoice.

The patient registration form should also inform the patient if the practice has any other commercial terms, such as charging for consultations that patients do not attend where they have not been cancelled in advance or cancelled at the last minute. These ,of course, are often referred to as DNAs (Did Not Attends).
Another area which often needs clarity is if the practice charges for items that are typically not covered by the insurance companies.
These can be items such as writing prescriptions or consultations carried out by phone.

A template to use
All of the above need to be incorporated into a patient registration form as well as any other commercial considerations particular to the specific practice – such as charging for domiciliary visits.
If the practice has a website, I would also suggest that the wording published on it matches your patient registration form so that the message is consistent across all forms of media.
There are too many variables across the sector to cover all of them in this article. However, I have provided an example on the right, which you could use as a template and then adapt to your particular practice.

Garry Chapman is managing director at Medical Billing and Collection

Use this form as a template and then adapt the wording for your practice:


This is a private appointment and the patient’s insurance provider will be contacted for payment. Should the insurance provider not cover the full cost of the treatment, then the patient will be responsible for settling any outstanding amount.
It is the patient’s responsibility to obtain authorisation prior to any treatment. The consultant will submit claims relating to the treatment direct to the insurance provider.

This is a private appointment and the patient is responsible for all charges, so payment may be requested in advance, if full costs are known, or immediately after any treatment.

The consultant’s fee schedule is typically met by the insurance providers. However, as there are so many different policies in existence, it is the patient’s responsibility to establish if their own policy will cover both the treatment and the costs of the treatment and identify if they will incur any shortfall.
The consultant’s fee schedule is not always covered in full by the insurance companies, as the consultant has his/her own price schedule.
As there are so many different policies in existence, it is the patient’s responsibility to establish if their own policy will cover both the treatment and the costs of the treatment and identify if they will incur any shortfall.
We can provide quotations upon request for any treatment.

If the patient fails to attend an appointment without providing notification of at least 48 hours by phone or email between Monday and Friday 9am-5pm, then they will be charged a cancellation fee of XX% of the consultation/procedure fee.
The consultant’s fees are completely separate to the invoices the patient may receive from the hospital for tests or procedures carried out.
The consultant’s fees for the following items are not typically covered under the insurance policies:

  • Home visits £xx
  • Phone consultations £xx
  • Prescription charges £xx

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