Do Your Patients Expect Something for Nothing?

iStock_000000385270SmallI would say yes.

However, I would submit that the reason our patient’s expect something for nothing is our fault, not theirs.

The truth is, we’ve given away so much over the years. And now that we want to charge for things (that have always cost us) like forms, after hour phone calls, and other things, people think we are now wanting to collect for things that they were lead to believe had no value.

Not to mention they often think we are nickle-and-diming them now.

But some practices have been very careful about not falling into this trap of giving away their time and their resources.

Take Village Pediatrics for example. Dr. Gruen and Dr. Gorman charge parents between $150 and $325 (depending on how many children) for a plan they call the added benefits plan. Here is what their website says about the plan:

This modest per-child administrative fee includes services that may be non-covered or non-reimbursed by your insurance company and are typically billed for at other medical offices. Such services include: e-prescribing, unlimited school/camp forms, as well as 24/7/365 access to the doctors without the use of a phone triage service. This fee has allowed Village Pediatrics to offer prompt and personalized care without dramatically increasing our practice volume, dropping insurance plans, or significantly raising our cash fees.

Why would parents pay above and beyond their health insurance premium every year to visit Village Peds?

Because Village Peds from the beginning decided to take a stance and tell parents, what they do has immense value. The time they spend with patients/parents in and out of the examining room is of great value. And if patient/parents want access to Dr. Gruen’s and Dr. Gorman’s valuable time and expertise, parents are going to have to pay for it.

I say, Good for them!! I applaud Dr. Gruen and Dr. Gorman’s efforts in establishing a practice that focuses on providing value worth paying for.

And my guess is that nearly 100% of Village Peds families pay the fee. Because all the other families that didn’t see the value, don’t have their children seen at Village Peds.

Here is the hurdle for me.

When I first read  the things Village Peds  offers  as a part of their added benefits plan, I said to myself, we can’t start charging like they do.  Why? Because all the things on that list our practice already provides without getting anything  for it.

Who’s fault is that? The patients/parents?

No. This is our mistake.

For those of us in the private health care world, we need to get over the fact that people are going to complain about paying for something they used to get for free. Heck, I don’t like to pay for something I used to get for free either. So we can’t hang that over our parents.

Furthermore, I’d emphasize that it is our responsibility to educate our parents that there is HUGE value in everything we do (both inside and outside the examining room).

If we don’t educate them, parents will continue to expect what they’ve always gotten. Which is something for nothing.

This is something I’m gonna start thinking about more. Especially if the plan is to remain an independent private practice.


  1. Our office started charging for after-hours phone calls years ago. We were told at the time that we’d lose patients. Ten years later and we’re the largest practice in the area and we RARELY hear complaints about the phone charge. I certainly agree that if there are no complaints if the value is real.


    • We had a similar experience except it was with our credit card policy. We require all private pay patients to leave a credit card on file as a guarantee to payment (like hotels do).

      A few families did leave, and some even came back. But overall, the overwhelming majority of parents in our practice didn’t have an issue with it. Sure, some complain, wrestle and push back, but when we stand firm, they fork over the card.

      Thank you for stopping by and leaving a comment Tim.



  2. Tammy Butler says:

    I love this article – it is so true! I have worked 10 yrs at an orthodontic practice and have felt like we give away way too much of our time and resources for free. Our patients will complain if we charge them for something that I KNOW they do pay for at other providers – it is just that they are USED to getting it for free from us! That is our fault and we need to change our methods. Good point, Brandon! The best things in life ARE NOT free!


    • Hello Tammy,

      So this happens in the dentistry world too? I’m not surprised.

      What I think also happens, is that as small business owners, trying to get a business off the ground, you want to inconvenience your customer as little as possible because you want that person to not only come back, but tell their friends. So we start doing these things for them under a customer-service gesture. But then, you realize these things are actually costing you money; and when you start charging for them, people get upset, as I eluded to.

      Thanks for commenting on the piece.


      • I definitely agree Brandon, as a new practice the focus is clearly on getting new patients and though I had a policy written that included fees for various things, such as forms, no shows, etc….I never implemented but I have to say the longer I let it go the harder it will be to get it going. Happy New Year…I am putting those policies in place!!