How to deal with patients asking for discounts in Private Practice

Patients’ asking for discounts is not uncommon in private practice. Doctors are not trained to deal with this. I will give you 2 incidents that happened to me recently and then give you some advise as to how to deal with these situations.

Unreasonable patients

A patient came to consult me from another city. She said I came highly recommended. I took a history from the couple and then examined her. I then explained the condition to the couple. Contrary to what was suggested by another gynaecologist, I told her that she probably does not need any surgical intervention. I also did not give her any medication. She went out and was not happy with my charges. My charges included a consultation and a charge for the ultrasound scan. She came again into the clinic and asked me to explain what my charges are for. I explained to her how I charged and she was still unhappy. I asked her what the charges she expected but she kept quiet. I told her that if she does not want to be charged for consultation and ultrasound she should have considered a public hospital. She left without saying anything. Later she wrote on a blog about how rude and unprofessional I was and that I even told her to go to a government hospital. I was distraught.

The second incident was a single lady with a gynaecological problem from another city. She also told me that I was came highly recommended and wanted an opinion. I examined her and agreed with the assessment of another doctor that she will need surgery. She said that she wanted to go for a vacation first and then do the surgery. I told her that, this was not a good idea. She just exploded in my clinic shouting at me and saying that I cannot relate to her needs.  I was taken a back by her reaction and told her I am not happy to handle her surgery. She said she wasted her time coming all the way down to see me and wanted a full refund of the consultation. I agreed and refunded all the fees. I told my nurse that I am never going to see this patient again.

Several months later she called back talking nicely to my nurses saying that she wanted the surgery done by me. I was not sure how to react and decided I will give her the benefit of the doubt. She came for another consultation. She looked different with a different coloured hairstyle. She was polite. She did not have insurance and wanted a discounted surgical fee. I realised that she could not get the surgery done at a cheap rate in her city. I told her that I would do it for her at a predetermined amount, which was much lower that the usual cost of the surgery. She did not mention anything at all about the earlier consultation and how I did not charge her. It is my practice that when I discount the surgical fees, I admit the patient to the most economical room which is a 4 bedded. However at the admission counter, she decided on her own, to be admitted to the most expensive room in the hospital.

I am usually cautious during surgery in this kind of patients in trying to minimise wastages in disposables. The surgery went on well and she was discharged on a Sunday. Usually, we check the bill on Saturday to ensure that the bill is according to the predetermined amount. I told her that the  final bill will be slightly more than what I had told her earlier because she was admitted to a more expensive room. On discharge the bill exceeded by RM 800. She refused to pay the extra and threw a tantrum at the payment counter. I told the discharge clerk to take the amount out of my consultation. I told her that we will discuss the excess on her return visit. I usually see my patients 1 week after the surgery to remove the sutures. She never came back for a return follow up.

Discount? What to do?

So what can we do when patients demand for a discount? Most patients are reasonable. I have no problems giving discounts to reasonable patients. One of my friends say that he has a standard protocol when a patient ask for a discount. He will give a 10 % reduction of his consultation. When a patient asks for a discount at the outpatient clinic, I ask them how much discount do they expect. If the amount seems reasonable and I think they are not taking advantage of me I will give the discount. Sometimes I tell them that this is not a  wet market and I don’t want to haggle because the amount being discussed is small. I usually end up waiving my entire consultation fee, which is usually RM 100, and only charge the ultrasound fees. As for inpatient fees I will tell them that the government has already predetermined what I can charge and I will give a discount on my charges. I will also show them the private health care code of charges. If they are agreeable then we proceed with the admission.

Advice

The following are my advice when patients ask for discounts:

1. For outpatient consultation, your nurse should inform them how you charge before the patient enters the room. This can be done when the appointment is made or when they reach the clinic. The patient must know your charges before she enters your room. If it is a long consultation and you think that you should charge more, tell the patient about it before she leaves your room. In that way, they will be no argument with your nurse at the counter.

2. As for the inpatient cost, it is good to tell them in advance what the total bill is going to be before they are admitted. This is especially so if the patient is cash paying. Sometimes the final bill may be higher because of surgical difficulties or complications and the patient need to know that as well. I usually tell an amount that is more than what I think the final bill is going to be so that when they see the final bill, and it is less than what was quoted, they will be happy.

3. I am always worried to operate on patients who are on a very tight budget because of the worry that if the total bill exceeds their expectation, then the only way I can get out of it, is by giving a reduction in my fees which has already been discounted in the first place.

4. When a patient is unhappy with the fees, ask them what amount will make them happy. Give the discount. The cost of having a bad review in the social media far exceeds the cost of the discount. I have learnt this the hard way.

Does the management understand this?

The management of hospitals do not understand the difficulties faced by clinicians. Patients want the best treatment at the lowest possible cost. Insurance companies are always watching what doctors’ charge because we have a fees schedule in the Private Health Care Act. Doctors face patients and have to convince them that they are the best to treat them. They have to make sure that the final bill is to their patients’ expectation. The management just collects the money. Sometimes in difficult situations the management will give some reduction in their fees but the amount is usually far lesser than what we doctors give during our daily practice.

When you start your practice, getting patients to your clinic and into the wards or operating theatre will be a challenge and sometimes you have to bend backwards to get the patient so that you can practice your art. However be careful!. You may end up doing a lot for a patient and taking all the responsibilities and stresses only to end up not being rewarded enough for the work you have done.

2/6/2021

Acknowledgement

I would like to thank Dr. Gunasegaran PT Rajan for reading through this manuscript

I would like to thank my wife Sarojini for editing this manuscript.