It’s always been expensive to go to the doctor. Now, however, it’s about to become worse. Insurance and physicians’ groups are noting a dramatic increase in the number and amount of doctors’ fees for services uncovered by insurers. These fees are being created with an eye towards boosting revenues, which have lagged for doctors during the past few years of economic decline. Of course, these fees might be serving to only drive patients further away from their doctors’ offices by making medical care even more difficult to afford.
The most common of the new fees is a charge for missed appointments, which can range from twenty to fifty dollars depending on the practice. Offices have also begun to charge for things that were previously treated as courtesies, such as filling out “doctor’s notes” for school, work, or sports teams or FMLA paperwork for childbirth and long illnesses. There is also, perhaps most appallingly, beginning to be a trend towards administrative fees charged on patients annually just for the privilege of being a patient of the practice. These fees range from thirty-five to over one hundred dollars.
Industry professionals have compared these new trends in the medical world to the influx of “a la carte pricing” for everything from extra luggage to pillows and earphones on airplanes. The Medical Group Management Association made this comparison recently, and pointed out that they do not advocate the extra fees because patients dislike them and insurance contracts may prohibit them. The Association compares the new doctors’ fees to the end of all-inclusive medical care.
Right now, the number of doctors charging these fees across the country remain in the minority. The ones who are doing it, however, claim that they have no other choice if they want to keep their heads above water and keep practicing. One doctor interviewed for a Washington Post story (Allan Greenlee of Washington, an internist) sent the whole of his practice (seven thousand patients) a letter asking for a voluntary thirty-five dollar annual administrative fee to help with costs not paid by insurance. Dr. Greenlee says that he received only two angry letters, and several extra donations from patients who wanted to pay on others’ behalf. Greenlee says that the fees are necessary if he hopes to “stay solvent.”
Doctors charging a la carte prices for care are treading a fine line, however, no matter how noble their intentions. According to WellPoint, the U.S.’s insurer with the most members, these physicians may find themselves in violation of their provider agreements. The problem arises when doctors are charging for things that are already being paid for with their insurance payments. John Syer, WellPoint’s vice president over provider contracting, claims that the company has indeed seen a spike in physicians charging new fees. Syers says that his office has received several inquiries from doctors thinking about charging new administrative fees.
It’s believed that a widening gap between insurance payouts and actual costs of providing medical care is the primary reason for doctors charging administrative fees, although there is no actual data available on the topic. The deflation of insurance reimbursements has led to sweeping, negative changes in the United States’ medical industry, including a shortage of primary care physicians (especially in rural areas), more medical students gravitating towards specialty fields, and the list of Medicare providers dwindling at an astronomical rate. Never has this problem been more acute than the present, with the enactment of a new universal healthcare law translating thirty-two million new consumers of healthcare flooding the market.
Doctors receive reimbursement for office visits, yet they claim that they remain unpaid for numerous activities that earn them no payment, such as returning patient phone calls and doing the paperwork for prescription refills. A study in The New England Journal of Medicine found in April that the activities consume a significant portion of doctors’ daily time. Hence the extra fees.
For their parts, patients tend to get angry at these fees. The same economic conditions that have negatively impacted doctors have also seen American families’ healthcare out of pocket costs skyrocketing. Being asked to pay extra fees on top of copays and deductibles is simply unacceptable, in my opinion. The fees that annoy me the most are no-show penalties. I had to cancel a dentist appointment a few weeks ago due to the fact that I had been in a car accident the previous day. Because I gave less than 24 hours’ notice, I was charged twenty-five dollars. An angry call to the office manager resolved the fee, but I remain irritated that I was charged one in the first place. When I go to a doctor’s office, it is not at all unusual for me to be kept waiting, sometimes for upwards of half an hour. Why is a doctor’s time more valuable than mine?
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