It depends on how comfortable you are with discussing the financial aspects of the treatment.

If you are comfortable, then do so, but bear in mind that patients will often not take in most of what you say on the cost, especially if they have just received some challenging news about their problem.

If you are not comfortable, as is the case for most Consultants, or if is not appropriate, then you will need to set up a separate process to cover that discussion away from your clinic.

This can be achieved by a call from you, your secretary (if they are happy to discuss finances), or a billing agent.

Some patients will need to ask in order to determine whether or not they are fully covered. Some will need to know to see if they can afford your treatment. In both cases the patient is then able to make an informed choice.

The key here is to minimise surprises.

The BMA (British Medical Association) and FIPO (Federation of Independent Practitioner Organisations) both recommend agreeing fees in advance with the patient wherever possible. This can be easily achieved by publishing them on your website.

You do not need to know all your fees, if you have a point of reference somewhere else. Such as a website, an insurance company fee schedule, or a knowledgeable person. But be careful if you do quote your charges, because the patient will remember what you said and you may be bound by  that answer.

There are several questions that you need to consider when setting your fees.

• What are your competitors fees?
• What fees have you agreed with the Insurance Companies?
• Do you have a niche, where you are the only Consultant with that skill?
• How many other similarly skilled Consultants are at the same location, or in the near geographical area?
• Do you want to align with, or base on, an Insurance Company Fee Schedule?
• What is the cost to you of undertaking that particular treatment? Is it worth your while?

It is also complicated by the varying positions of the insurance companies.

• For BUPA and AXA PPP, have you entered into an agreement on your fees, if so you will be bound by that agreement, unless you withdraw from it and de-register with these insurance companies.
• For some insurers, there will be no cap, but they may point out to the patient that your fees may not be covered in full and offer another lower priced Consultant to the patient.
• For other insurers, they will set their remuneration rates at a rate they consider reasonable, and it is up to the patient as to whether or not they are willing to accept your rates.

Start by finding out what other Consultants charge, you can often do this by asking them, checking on their website or contacting the hospitals where they practice.

Bear in mind that it is illegal for you to agree your charge with the other Consultants, as that constitutes a price fixing cartel.