The costs that arrive in month four

Almost every complaint about the cost of treatment turns out, on inspection, not to be a complaint about the headline price. People generally know what the headline price is. They agreed to it. What they object to is the shape of the bill afterwards, which was not the shape they were shown.

Four places cost hides

• The introductory rate. A first-month price that is genuinely lower, presented at a size that implies it is the ongoing one.
• The consultation, unbundled. Quoted separately, charged separately, and easy to read as included when it is not.
• The escalation. Cost that rises with dose, so the same treatment costs more in month six than in month one by design.
• The renewal. An automatic continuation whose date is disclosed correctly and noticed by almost nobody.

None of those four is necessarily improper. All four are usually written down somewhere. The issue is that they are written down in four different places, at four different moments, in a process built to be completed quickly.

Why month four

The reason people describe the same month is arithmetic rather than mystery. It is roughly when an introductory rate has lapsed, a dose has moved up at least once, and a renewal has run — the first billing cycle in which everything is simultaneously at full price.

I had budgeted correctly for what I was told and incorrectly for what I was charged. Both of those were the same number, four months apart.

Illustrative composite

Questions that surface it early

The useful move is not distrust. It is asking for the month-eight number rather than the month-one number, in writing, before the first payment — because the month-eight number is the one you will live with, and it is almost never the one on the page.