Informed financial consent

• Tailor your IFC process to the patient’s individual circumstances and the specific procedure or treatment.
• The level of documentation required increases with the complexity of the procedure.
• A thorough IFC process will help reduce the risk of bill shock and the potential for a complaint or claim if something goes wrong.

Informed Financial Consent (IFC) is the process of providing patients with clear, timely information about the expected costs of their healthcare - including fees, rebates, and any likely out-of-pocket expenses. This helps to ensure that patients understand the financial implications of their treatment and can make a voluntary, informed decision about their care.

Obtaining IFC is good practice, and is part of your ethical and professional responsibilities, as outlined in the Medical Board’s Code of Conduct for doctors. Clear communication about anticipated likely costs helps prevent misunderstandings. When a patient experiences unexpected expenses, particularly in situations where an adverse outcome has occurred, it can inflame tension and significantly increase the likelihood of a patient making a claim or complaint.

IFC should be provided before the patient incurs any cost, giving the patient time to review and consider those costs. For example, this might be at the time the patient books an appointment for consultation or as part of an initial discussion about treatment or a procedure. It may need to be revisited if circumstances change, such as adjustments to the treatment plan or additional procedures.

Even after the initial discussion, the message can be reinforced at key points.

IFC can also be incorporated into the clinical discussion when obtaining consent from the patient for a procedure or treatment. This can be particularly relevant when discussing the various options and cost implications.

In many cases, the two consent processes - clinical and financial - are handled separately as they may involve different team members (e.g. medical practitioner or practice staff). However, the medical practitioner may need to refer to the financial implications of treatment during the clinical consent process.

Like clinical consent, financial consent is a process not a form. It involves discussing costs and expenses with your patient, in a way they understand, and obtaining their agreement to proceed.  Discussions can be supported by written information provided to the patient or available on your website.

Emergency situations can affect how and when informed financial consent (IFC) is obtained. Not all emergencies are the same, and your approach should be guided by the specific clinical circumstances. 

Patient care and wellbeing must always take priority. If discussing fees would delay or compromise care, it is appropriate to defer IFC. 

Where there is time to have a discussion, even if limited, you should still aim to provide IFC before treatment. For example, if a patient is added to a procedure list at short notice but there is still an opportunity prior to surgery, you or your staff may be able to provide information about fees, rebates and likely out-of-pocket costs. 

In more time-critical situations, a modified approach may be appropriate. This could involve a brief, general discussion with the patient, their family or a substitute decision maker. At a minimum, this should include an indication that out-of-pocket costs may apply and that more detailed information will be provided when practicable. 

In a life-threatening emergency, where the patient is unable to engage in a meaningful discussion or there is no opportunity to consider options, IFC before treatment is not expected. In these circumstances, the focus must be on providing necessary care, with financial information provided as soon as reasonably possible afterwards. 

Where IFC cannot be obtained before treatment, this does not prevent you from charging for the care provided. You are entitled to be paid for your services, including emergency or after-hours care. While setting expectations in advance can be helpful, this will not always be practical in emergency or urgent clinical settings. 

You may be worried that discussing potential costs may cause further distress to your already unwell patient, but this should not be a reason to avoid obtaining IFC before treatment. If possible, consider having their support person present for the discussion. 

Informed financial consent can be implied, provided verbally, in writing or electronically, depending on the circumstances.

The appropriate format often depends on how complex the financial aspects of the consultation or procedure are. When the fee structure and potential out-of-pocket costs are more complicated, a formal written or electronic approach is preferable to ensure clarity and transparency. Ensure the patient has adequate time to consider the information. The decision on which approach to use should be made by the medical practitioner, while the implementation – such as preparing and delivering the information - can be managed by appropriately trained staff.

For straightforward situations - such as a fixed fee for an initial or single consultation - verbal consent is generally acceptable. This often occurs when the patient books the appointment, with practice staff confirming the payment amount and any relevant Medicare rebate. Verbal IFC can also be appropriate in situations like discussing the cost of a new prescription.

When a procedure involves multiple elements - such as a hospital stay or additional investigations - it is preferable to provide the patient with written information about costs and expenses. This can be delivered as a printed handout, an email or other electronic communication or through an app, outlining the fixed fee structure and any potential additional costs.

If the procedure is standardised, the IFC can follow a set format, with either pre-populated amounts or clear guidance on where the patient should go to confirm other associated costs. Providing written information reduces your risks, ensures trust and transparency as well as helps patients understand the full financial implications before proceeding.

For complex procedures where multiple charges, potential additional costs, or significant out-of-pocket expenses are expected, IFC should be provided in writing and tailored to the patient's specific circumstances. This document should include a detailed breakdown of fees and a description of any foreseeable additional charges.

In situations such as providing a prospective patient with information about a consultation fee or treatment fee structure, there should be evidence that the financial information was provided and agreed to by the patient, or parent/carer. This may be documented in a new patient form or electronically when booking an appointment using an online service.

If you have a brochure outlining potential out-of-pocket costs you should document that the brochure was given to the patient in their clinical record. This can also be done using an electronic format.

In circumstances where the patient may incur significant out of pocket expenses, consider creating a document specific to the patient’s situation. The patient should review, accept and sign the quote, then return it to the practice. A copy should be retained. This formal approach helps prevent misunderstanding about costs.

Things you should consider including in the discussion or document

When providing informed financial consent, consider including the following details to help patients make an informed decision:

• MBS item numbers and rebates
• hospital costs or where to find them
• a recommendation to check with their private health insurer
• the potential for out of pocket costs – including those from other specialists (e.g. anaesthetist) and related services such as radiology or pathology
• implantable protheses and devices costs
• alternative options, such as where equivalent care can be provided in the public system
• general information about the potential variations for unforeseen circumstances
• possible ongoing costs
• total quoted cost, clearly labelled as an estimate or range if exact figures are not possible

Additional considerations:

• whether a deposit or full payment for out-of-pocket expenses is required
• refund policy if payment is taken prior to surgery and the surgery does not proceed
• what will happen in the event of an adverse outcome or prolonged stay
• other incidental expenses, such as over-the-counter medication
• any direct financial interest the practitioner has in connection with the location or associated services

The Medical Board’s Guidelines for cosmetic surgery and non-surgical cosmetic procedures have some specific requirements for IFC and financial management. Medical practitioners obtaining financial consent for these types of surgery and procedures must familiarise themselves with these requirements in full. In summary, these include the need to:

• provide a breakdown of all costs and the total cost
• advise there is no Medicare rebate available
• allow the patient a cooling off period
• not offer any inducements or encourage use of financing schemes.

Medical Board of Australia - Guidelines for registered medical practitioners who perform cosmetic surgery and procedures