Are specialists charging too much for their services?

“An agreement is an agreement; all parties must commit to it. We expect doctors to hold up their part of the deal.” Christian Mutual, a Belgian mutual insurance firm, has taken to lecturing the thousands of specialists who, according to patient testimonies, have not been respecting the doctor-insurance provider agreement. The settlement establishes, among other things, maximum fee levels. In exchange for certain social advantages, the practitioners that sign it – known as conventionnés – must respect the agreed rates.

 

According to Christian Mutual, while GPs and the large majority of medical specialists do not pose a problem, a part of the latter group has not exactly been sticking to the letter of the agreement. In fact, a survey carried out on 106,000 members post-consultation reveals that 23 % of specialists who have signed the agreement (those that have not signed have variable but not necessarily astronomical rates) overcharge for their services. By how much? Often by a few Euros, and sometimes by a lot more. The average hike comes to approximately nine EUR.

 

The “specialists” in unjustifiable extras are first and foremost gynecologists: 50 % demand more than is stated in the agreement. But a third of cardiologists and ENT specialists have followed suit. “As far as gynecologists are concerned, it’s even more problematic, given that it’s one of the specialties with a lower agreed fee,” says the insurance company.

 

What is Christian Mutual going to do with these figures? Without personally targeting the medical specialists involved, it plans to pass the problem on to their specific associations. In more general terms, it has called for the introduction of actual bills for health-related services – the only way, it says, to achieve real transparency in the sector. “It is quite striking that a patient does not receive any proof of payment for a doctor’s visit. He or she receives a consultation certificate, but that does not generally state the amount paid,” explains Jean Hermesse, secretary general of the insurance company.

 

The survey also reveals another worrying aspect of this issue: the majority of respondents do not know if their specialist is conventionné, i.e. signed up to the doctor-insurance provider agreement, and some are not even aware of what the term conventionné actually means.

 

ÉRIC BURGRAFF

 

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