Private fees without guilt: how to set, explain and stand behind them

Many GPs undercharge out of guilt. How to set private fees that reflect your work, explain them clearly and keep patients' trust.

One of the most common things I hear from GPs isn't a billing question at all. It's a feeling: "I feel bad charging patients."

I understand it. We went into medicine to help people, and money can feel like it gets in the way of that. But I've seen what happens when that guilt drives the fee schedule: GPs who are exhausted, underpaid, and eventually leave, and practices that can't keep their doors open. That doesn't help patients either.

Start with what the care actually takes

A fee should reflect the time, skill and responsibility involved. A 40-minute menopause assessment, a complex mental health consult or a procedure with counselling beforehand is not the same as a quick script review. When your fees don't recognise that difference, you're effectively telling patients the extra time has no value.

Look at your longest, most complex appointment types first. That's usually where the gap between the Medicare rebate and the real cost of the care is widest.

Decide who you bulk bill, on purpose

Bulk billing is a choice, and it can be a good one for the right patients. The problem is when it happens by default, or because it feels awkward to ask. Decide as a practice who you bulk bill and why, write it down, and apply it consistently. That's fairer to patients and to your GPs.

Remember the basic rule: if you bulk bill a service, you can't charge the patient anything extra for it.

Explain fees before the service, not after

Patients rarely object to fees they understood in advance. What damages trust is surprise. Good practice looks like:

Fees published clearly on your website and at reception

Reception telling patients the expected cost when they book longer or procedural appointments

The GP mentioning costs before starting a procedure or extended assessment

A simple note in the record that fees were discussed

Informed financial consent isn't a formality. It's part of treating patients as adults who can make decisions about their care.

Keep it human

Having clear fees doesn't mean you can't be flexible. Most GPs will always make room for a patient in genuine hardship. The difference is doing that as a conscious decision, not as the default because the conversation feels uncomfortable.

You're allowed to be paid for good care

Better Billing has always been about one idea: GPs should be paid properly for the care they're already giving. Sometimes that means finding missed MBS items. Sometimes it means the harder step of setting a fee that reflects your work and saying it out loud.

Want an outside view on your billing and fee structure? Our MBS Health Check reviews your high-value items and shows where you stand. Learn more at betterbilling.com.au.