Dr. Amy Nett: We’ve changed this. We used to collect the entire fee up front, but every once in a while you’ll have a few patients who do the case review and they might just kind of not follow through with the case review appointment or maybe they get pregnant and say, “Well, I just want to come back and do the case review in a year or so, after I’ve had my child and I’m weaning,” or something like that. So what we do now is we actually divide the case review fee up into two parts. For the initial consult, we charge, I think, about 25 percent of the total fee. Let’s say the total fee is just $1,000—and there’s a little bit different fee structure for the different clinicians in our group—but if the case review fee is $1,000, we charge $250 for the initial consult, for that initial 30-minute appointment, which is a little bit more than the routine follow-up 30-minute appointment because there’s additional admin work that goes into onboarding a new patient in terms of getting them registered into the EHR and all of the paperwork. So the fee is a little bit more than for a standard 30-minute appointment because of the admin work that goes into it, and then the remaining 75 percent we collect at the time of the case review appointment.
That’s the way we’re doing it now, and I think it works a little bit better than collecting all of it up front because in those few patients who do just kind of wander off and don’t complete the case review process, it can be such a headache to deal with the refunds, so we’ve just found it easier to do it this way.