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True that, but IMHO sometimes thay are out of line.  I tried to use them to get a letter to send to the Social Security Administration simply stating 2 of the medications I take daily are not allowed by the FAA.  They wanted over $1000 for the letter.  I called the AME I'd seen for years and asked him what to do.  He said, come see me.  I'll deny the medical and give you a letter for the SSA.  You'll eventually get an "offical" letter from the FAA too (that took over 6 months BTW).  All done for abouot $150