So your clinic has paid to have one or more providers become certiﬁed Medical Examiners. You have trained your staff to be familiar with DOT forms and procedures. Now what do you charge for a DOT medical exam?
A survey of occupational medicine clinics recently described the following (results reported list average, lowest, and highest charges reported):
OT Medical Examination only, average fee: $109 ($40 - $289)
-includes required vision, hearing (whisper test), dipstick urinalysis, blood pressure, and pulse.
Audiogram: $36 ($25 - $112)
Pulse oximetry: $12 ($0 - $22)
Fingerstick blood glucose: $10 ($0 - $28)
Electrocardiogram: $72 ($45 - $175)
Spirometry: $34 ($20 - $142)
Hemoglobin A1c: $34 ($14 - $112)
The numbers illustrate the wide variation among clinics. Many clinics contacted indicated that they had different charges for self-pay examinations and those paid for by employers, usually with a discount for self-pay. A few indicated that they also performed DOT medical examinations in the context of annual medical examinations paid for by insurance.
The Department of Transportation has long indicated that there are no regulatory requirements regarding who pays for DOT examinations or on how much can be charged. In the survey, 74% of examinations were paid by the employer, 26% by the driver (either self-pay or using health insurance).
Market conditions are likely to determine what can be charged in most cases. In rural areas where there are limited numbers of certiﬁed Medical Examiners, charges may be higher. In markets with stiff competition, charges may be lower. Often charges for DOT medical examinations are just a part of a package of services that may be provided to employers, including other types of ﬁtness for duty examinations, preemployment and preplacement examinations, drug and alcohol testing, and Workers’ Compensation injury treatment.
Keep in mind that MEs, and clinics that provide DOT medical examinations, have broad discretion in terms of what to charge and when to charge for new examinations. Although FMCSA requirements now require a new complete examination in many circumstances – e.g., when time-limited certiﬁcation has been issued for any reason –the FMCSA is silent on charges related to examination services. MEs may provide new complete examinations but may choose to charge a reduced fee, or no fee at all, if they so choose.
As with any business decision, the desirability of charging a full examination fee each time a complete examination is performed, versus charging only a full examination fee, for example, once per year, will depend on the business environment. For employers as well as individual drivers paying for their own examinations, the certainty of a once per year or once per two year fee versus the uncertainty of being charged every time a new examination is performed, may be attractive and may lead the employer or driver to choose one clinic over another.
With few exceptions, most of the services related to a driver examination have no associated ﬁxed costs such as laboratory fees or X-ray interpretations, so clinics may ﬁnd that it makes business sense to provide additional examinations for reduced fees. Clinics may even consider charging less for examinations during off-peak business hours when clinic volumes are lower, as well as bundling DOT medical examination fees together with other packages of services provided to employers such as preplacement medical examinations, drug and alcohol testing, and Workers’ Compensation treatment.