Dear Sir or Madam:

Recently I received a bill for services in the amount of $226.06. While I did get adequate, nay, good care I am quite certain this is a tremendous overcharge for what I received.

I came on a referral with a diagnosis of acute taliofibula ligament strain. My appointment was for 1:00pm. I arrived at 12:45, filled out the appropriate forms, and was ready to be seen by 1:00. I was eventually escorted to another room at 1:45 where I was eventually greeted by Lori Cardwell, a Physician’s Assistant – not a doctor. Lori was great, but she spent a total of 5 minutes with me. In that time she looked at my ankle and gave me an Aircast brand brace.

I trust Lori, and I’m healing nicely, but I can’t understand how you can get $226.06 out of 5 minutes. At that rate I would be paying $4521.20 per hour. Let’s assume that half of that money goes to the practice itself; paying staff, lease, insurance, office supplies, medical equipment, etc. That would mean that Lori, a Physician’s Assistant, earns an hourly rate of $2260.60 per hour. Assuming she works a 35 hour week, that’s almost $80,000 per week before taxes. That’s almost as much as the President of the United States makes in a year. Does Lori Cardwell make more money than Brett Favre? Bruce Willis? Arnold Schwarzenegger? For her sake I hope she does.

I, however, do not. But, like Lori, my time is valuable and I understand the concept of getting paid for your work, so here’s the deal. The price of the brace that I got was $48.95. That’s the retail price on the Aircast website before taxes and shipping. While I’m sure you get some kind of bulk rate industry wholesale discount I’ll be generous anyway and chalk the price up to $60.00. For the 5 minutes I saw Lori I’ll pay $20.00. That’s still $400 an hour, a rate in league with high priced Hollywood criminal lawyers like Johnny Cochran. It’s generous. That would bring my total bill to $80.00. Since I already gave you $50.00 that would leave my balance at $30.00 which I will gladly pay you.

My hourly rate for dealing with bureaucracy is $100 per hour. That is the amount I charge for things like waiting in waiting rooms, filling out unnecessary forms, holding on the phone, and writing letters explaining why I won’t pay NASA prices for services rendered. I spent a total of 45 minutes writing this letter, putting it in an envelope, addressing the envelope, affixing a stamp, and putting it in a mailbox. $75. I spent another 45 minutes in your waiting room. $75. The price of a stamp: $.45. The price of a sheet of paper and the ink from my printer: $.50. Your total bill for my time: $150.95. Since this is our first encounter, and since I am pleased with Lori and the services I received I am waiving my bureaucracy fee. If, however, you do not respond to this offer in a humane and personable way… like a phone call, or a polite letter from someone that has some authority in this matter… if you decide to go the traditional route of sending me agitated bills and attempting to make me fight my way through red tape I will ABSOLUTELY REINSTATE MY FEE and compound to it any more of my time and resources spent on nonsense. Make no mistake, you’re not dealing with a mindless rube that gets nervous at the sight of an official letter and bends over to the whim of bloated institutions. I know precisely what the consequences will be if I don’t pay you any further attention and ignore you completely. Are you aware of the consequences you will face if I send you to a collections agency? Can your practice afford to deal with the blemish on your credit record? If it comes down to it I am willing to see this through to a trial with a jury of my peers. Are you?

My offer stands. I think I am being overly generous. If you’d like to work this out with me I am willing to listen. You may write me back at this address, you may call me on the phone (my business hours are 11:00am to 2:30pm Saturday – Thursday), or you may e-mail me. My preferred medium is e-mail. If you go that route it will show me that you take me seriously and I will take it as a symbol of good faith that you are reasonable. Until then the ball is in your court.

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