More Family Docs Charging Patients Administrative Fee

A growing number of primary-care physicians are hitting their patients with another charge: an annual "administrative fee" of $100 to $250 to help the doctors defray the costs of running their practice. The fees generally cover the amount of time they spend giving medical advice over the phone, e-mailing patients, maintaining medical records and talking with insurers to argue coverage denials or get certain prescription drugs.

The physicians themselves point out that while the administrative costs of operating a doctor's office have risen and the demands on them have increased, reimbursement rates from insurers have stagnated. But some doctors have paid a price in lost patients. And some health insurers say the fee practice violates their contracts with the doctors, who argue they are charging for services not covered by these contracts.

Dr. Curtis Robinson in California instituted the fee concept two years ago: $120 per individual and $210 for a family. Existing patients received a 10 percent discount off the fee. But even a modest administrative fee is not without risks. Its biggest detractors are health insurers, who have accused some doctors of violating the terms of their contracts by charging for services already included under the terms of the health policies. Robinson said Anthem Blue Cross has accused him of fraud. But Robinson stands by the legality of the fee, explaining that his contract applies only to covered services. He said the services he includes in the fee are clearly not covered because insurers have denied payment.

James Doherty, a Maryland health care attorney who has delved into the fee issue, said physicians can charge patients for uncovered services. But he advises doctors to charge for services their patients receive rather than require a flat fee for all of them. That way, they would avoid any legal ambiguity and the possibility of charging patients for services they may not need or want. The doctors interviewed for this story all said they preferred an annual fee because charging individual patients for each letter or form would add to administrative costs and make patients feel as though they're being nickel-and-dimed. (San Francisco Chronicle)