The Bad Execution

The implementation, however, demonstrates a profound misunderstanding of customer psychology and the patient relationship. Patients receive bills for simple administrative questions like: “When can I schedule my next appointment?” or “Can you send me the form I need to fill out before my visit?” Some healthcare organizations charge $65 per message thread, while others have implemented complex tiering systems based on message type, length, and response time.

The campaign suffers from several flaws:

– Misalignment with patient expectations: Patients view administrative questions as part of the service they’re already paying for through visits and procedures, making these charges feel like double-dipping.

– Poor communication of value: Little effort is made to explain why these charges exist or how they benefit the patient experience, leading to perceptions of pure greed.

– Inconsistent application: Fees often appear unexpectedly on bills, with front-desk staff unable to clearly explain when or why messaging incurs charges.

The Aftermath and Fallout

The consequences of this approach extend beyond the small dollar amounts collected:

– Decreased patient satisfaction scores, with research showing that unexpected fees are the #1 driver of negative healthcare experiences

– Reduced patient engagement with digital health tools that could otherwise improve health outcomes

– Increased phone calls and in-person visits for simple questions, actually creating more administrative burden

– Patient attrition to competitors who don’t nickel and dime for basic communication

According to research from Press Ganey, 63% of patients report they would consider switching healthcare providers over unexpected fees, even when those fees are relatively small. [1]  Additionally, a study in the Journal of Healthcare Management found that acquiring a new patient costs 5-10 times more than retaining an existing one. [2]

Key Takeaways for Marketers

Let’s extract some valuable lessons from this blunder that you can apply across industries:

1. Calculate Customer Lifetime Value Before Introducing Microfees
Small fees might seem insignificant on a balance sheet, but they can have large psychological impact. Before implementing any new charge, calculate the lifetime value of your customer and assess whether the short-term revenue is worth the potential attrition risk. Research from Bain & Company found that increasing customer retention by just 5% can increase profits by 25-95%, depending on the industry.[3] That revenue makes microfees look like pennies in comparison.

2. Distinguish Between Revenue-Generating and Relationship-Building Interactions
Not every customer interaction should be viewed as a billable opportunity. Some touch points exist primarily to strengthen relationships, build trust, and create positive associations with your brand. According to the Customer Experience Impact Report, 89% of consumers have stopped doing business with a company after experiencing poor customer service.[4] Basic communication should be seen as an investment in retention, not an opportunity for incremental billing.

3. If You Must Charge, Be Transparent and Demonstrate Value
If certain interactions genuinely require fees to be sustainable, be upfront about costs before the interaction occurs, and clearly articulate the value the customer receives.
The Journal of Business Research published findings showing that price transparency can increase customer trust by 44%, even when the prices themselves remain unchanged.[5]

Bottom Line

Remember, the difference between a loyal patient (or customer) and one actively searching for alternatives often comes down to how valued they feel. While charging for administrative questions might add a few dollars to this month’s revenue, it simultaneously activates the customer’s mental calculator to reassess whether your service is worth the total cost—both financial and emotional.

In healthcare, providers should consider the entire patient journey, not just discrete billable moments. Those small fees might eventually cost you $5,000 in lifetime patient value.

Remember, these same lessons are also applicable across non-healthcare businesses.

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