Pricing a medical consultation isn’t about copying a competitor or “going with a feeling.” It’s a management decision that affects financial sustainability, perceived quality, and schedule predictability. When pricing is set without a method, clinics tend to fall into one of two extremes: high volume with tight cash flow, or higher prices with idle capacity and difficulty attracting patients.
In healthcare, the sensitivity is greater because clinical time is limited, fixed costs are heavy, and the mix between private pay and insurers/health plans changes the game. The goal is to reach a price that is fair for the patient and viable for the operation—without relying on discounts to “hold” the schedule. In this article, we will cover How to Price Medical Consultations Correctly
What “pricing correctly” means in day-to-day practice
In practice, pricing correctly means sustaining three pillars at the same time:
- Covering costs and taxes (without the illusion of “profit on paper”).
- Paying fairly for the medical act and the team, with margin to reinvest.
- Reflecting positioning and experience (the value perceived by the patient).
When these pillars are aligned, pricing stops being a guess and becomes a strategy: you know your minimum floor, understand your market ceiling, and can justify the fee with a coherent experience.
Price components: costs, taxes, and real capacity
Before talking about “margin,” you need to organize costs and what your schedule can actually deliver.
Before we move on, one important note: if you manage a healthcare clinic and need better scheduling organization, a secure electronic health record, and centralized financial processes, Ninsaúde Clinic can streamline your daily operations. Get in touch to learn more.
Fixed costs
These exist even when the schedule is empty. Common examples:
- Rent/condominium fees, internet, and infrastructure
- Administrative payroll and front desk
- Accounting, practice management software, and phone systems
- Cleaning, maintenance, and depreciation
- Ongoing marketing
The central point here is real capacity. If the clinic was designed for 800 consultations/month but delivers 500, fixed cost per consultation increases—and pricing needs to reflect that (or management must improve productivity).
Variable costs
These grow with the number of visits:
- Supplies and materials
- Commissions and production-based payments
- Payment collection costs (cards, payment links, bank transfers). In Brazil, for example, Pix may also apply.
A simple step that helps a lot is separating variable costs by type of visit (first visit vs follow-up/return) and by specialty, because consumption and time are not the same.
Taxes and “invisible” losses
This is where the difference lies between “looks good” and “closes in cash.” Consider:
- Tax regime and effective tax burden
- Acquirer/early payout fees (cards)
- Discounts, claim denials/adjustments (glosas), and nonpayment
Ignoring this often creates prices that sell well but don’t support growth, staffing, or improvements.
The 3 pricing methods (and why the hybrid is the safest)
No single method solves everything. The most stable combination is usually:
- Cost + margin to guarantee a sustainable floor.
- Market to check coherence with your area and audience.
- Perceived value to sustain positioning and avoid price wars.
With this tripod, you avoid both “charging too little and not closing the numbers” and “charging too much without delivering a compatible experience.”
Step by step to the minimum viable price (no guesswork)
Below is a direct script to reach the floor safely.
Calculate the clinical hour cost
- Add up your monthly fixed costs.
- Estimate your real productive hours for the month (include breaks, no-shows, documentation/medical records time, and meetings).
- Formula:
- Clinical hour cost = fixed costs ÷ productive hours/month
This number is critical: it shows how much your structure “costs” per hour before any margin.
Convert to cost per consultation
Now convert by the average time:
- 30 min = 0.5 hour
- 45 min = 0.75 hour
- 60 min = 1 hour
Then add variable costs and “leakage” (fees and taxes). That gives you the total cost per consultation.
Define margin with intention (not impulse)
Margin isn’t “leftover”; it’s what protects the clinic and enables evolution. In practice, think of three destinations for results:
- Operating profitability
- Cash reserve (seasonality and unforeseen events)
- Investment (team, infrastructure, technology, marketing)
If a clinic lives “on the edge,” any schedule drop becomes a crisis—and pricing becomes hostage to the short term.
Validate with market and positioning coherence
Before publishing your fee table, check:
- Does your experience justify the price? (punctuality, welcome, clarity)
- Are there concrete differentiators? (protocols, follow-up, resolutiveness)
- Does the patient understand the rule? (returns, duration, channels, payment)
A price above the market can work very well—as long as the experience matches.
Private pay, insurers, and schedule mix: how not to “sink” into low ticket
Insurers/health plans can be strategic, but they require management. The mistake is analyzing only the “fee schedule” and not the net value.
Compare net revenue (not just the table)
Evaluate by insurer/plan:
- payment timelines
- denials/adjustments and rework
- administrative cost of billing
- the occupancy it truly brings (and at which hours)
Sometimes a plan “fills” the schedule but consumes the best hours and reduces the month’s margin.
Set mix rules and protect premium windows
A management practice that reduces stress is to establish:
- % of schedule for private pay
- % by insurer/plan (prioritizing the most sustainable)
- protected premium hours (don’t use them for low ticket)
Without rules, the mix “slips” and the clinic loses control of results.
Follow-ups, bundles, and telemedicine: clarity avoids conflict and protects margin
Poorly defined follow-up rules are one of the biggest sources of friction and revenue erosion. Best practices (adapt to your specialty):
- Follow-up window (e.g., up to 30 days) with a clear purpose
- Paid follow-up when there is a new complaint or new investigation
- Bundles/care pathways (when clinically appropriate)
- Telemedicine priced coherently to the format and time
The goal is not “to charge more,” but to eliminate case-by-case negotiation and give predictability to the patient and the schedule.
KPIs that show whether your price is right (or needs change)
Pricing isn’t static. Track simple indicators:
- Schedule occupancy rate and no-shows
- Revenue per clinical hour (one of the most revealing)
- Average ticket per patient (including follow-ups/bundles)
- Margin by channel (private pay vs insurers vs telemedicine)
- Cost per visit by specialty
If occupancy is high and revenue per hour is low, the issue is usually price, mix, or visit length. If occupancy is low and price is high, the bottleneck may be positioning, experience, and acquisition.
Technology to price better and sustain fees with experience
A common pain point for managers is deciding without data: scattered costs, confusing payouts, delayed reports, and little visibility into margin by channel. Technology solves this by centralizing scheduling and finance, reducing rework and making decisions objective.
In Ninsaúde Clinic, for example, you can track accounts payable/receivable, cash flow, and an income statement (DRE), as well as configure commissions and standardize routines that reduce no-shows and increase productivity—factors that directly impact cost per consultation and the confidence to adjust fees.
Another frequent pain is losing revenue due to weak post-visit engagement. When the clinic maintains active follow-up, returns happen more naturally and the average ticket improves without “forcing” the first-visit price. In Ninsaúde CRM, for example, you can segment patients by inactivity time and activate follow-up and check-up campaigns with a few clicks.
Frequently asked questions about consultation pricing
1) Can I charge differently for the first consultation and the follow-up?
Yes. The first visit usually requires more time and investigation. The essential point is to have a clear rule and communicate it before scheduling.
2) Is it worth lowering prices to fill the schedule?
As a permanent strategy, it tends to erode margin and positioning. In most cases, it’s better to adjust mix, reduce no-shows, improve the experience, and work on perceived value.
3) Can working with insurers/health plans be profitable?
It can, as long as you control denials/adjustments, administrative cost, and occupancy. Without net-revenue analysis and mix management, it’s common to generate volume with low margin.
Well-defined pricing, a stronger clinic
Pricing consultations correctly means combining method and positioning: knowing the minimum floor (costs + taxes), validating coherence with the market, and sustaining value with a consistent experience. With clear follow-up rules, mix management, and KPIs like revenue per clinical hour, you gain predictability and confidence to adjust fees transparently—preserving the patient experience and the financial health of the operation.
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