Anyone have to pay an annual "Administrative Fee" to their doctor??

[daughtersrus]

A couple of years ago I went to a (contracted) lab to have some blood work done. A few weeks later I got a bill for the plebodomy (drawing the blood). The lab billing department told me that only the lab work was covered by my insurance and not the drawing of the blood. My insurance company said that the agreement with the lab is that they get paid for the lab work and drawing of blood is just part of it and is considered free.

Of course the lab billing department was argueing with me about this over the phone. So I told them I was not paying, and that next time I came in they can give me the needle and I will draw my own blood. This shut them up real fast and I never heard from them again.

Several years ago I ran into a similar problem. DD was having surgery at a hospital that participates in our PPO. The surgeon also participates.

A few weeks after the surgery, we got a bill from the anesthesiologist. Our insurance was paying a much lower rate because he did not participate with the PPO. I argued with the insurance and they wouldn't budge. I finally got a hold of someone pretty high in the billing department at the hospital.

I pointed out to her that I had no choice over who they were going to assign to DD. They agreed that we shouldn't be responsible for the discrepancy. She contacted the anesthesiologist and made them adjust the bill. Shortly after that, we got a note from the hospital saying that they were requiring all anesthesiologists to join all of the insurance plans that the hospital participated in to avoid this problem in the future.

 

[ReneeQ]

Actually, doctors aren't required to file your paperwork with the insurance. Most do it as a service, but it's not required. They could give you a superbill and have you file yourself. I have to do this with two doctors who no longer accept insurance payments directly.

Interesting. With my insurance I have a $30 copay for the office visit, which I have to pay at the time of the visit. SOMETIMES the dr. can get additional payment, depending on how extensive the OV was, BUT they have to get the additional part from the ins. co., so they do have to file for it, since the dr. can't require me to pay more than $30.

For anything else done in the office (labs, xrays), my ins. pays 90% and I pay 10%. But they can't require me to pay the 10% until the ins. has paid the 90%. So, again, they have to file, if they want the payment.

Since they agreed to participate with my ins. co. and to be a provider, the ins. filing responsibility is on them, not me.

 

[ReneeQ]

It's common here. Our pediatrician charges $10 annual fee or you can pay a per form fee of $20. It's cheaper for me to pay the $10 fee. My ob/gyn also does this. For OB patients, it's $75. For gyn patients, it's $30. They also offer a per form fee as well. I pass on paying the annual fee and just wait for the form since I don't have any forms to fill out. However, when I had my dd, I did pay the $75 fee since I needed disability forms filled out.

What you are explaining makes sense, as it seems to be a fee for form completion. But my dr. wants to charge an annual fee just to be a patient there, and to help them cover the cost of simply doing business. I am not requesting any extra services or any forms be filled out. I get nothing for the fee, except I get to remain their patient.

 

[ReneeQ]

It sounds to me like your specialist just had his contract re-negotiated with the local HMO/PPOs and he didn't get what he wanted as a rate so now he's passing along the difference in the form of a fee.

But is this allowed/legal, IF he is a contracted provider with my plan,and my plan states what my co-pays and fees are? That's what I have to find out.

 

[lpandorf]

My Mom's doctor charges $8 if they have to call in a prescription for her.

One of my husband's doctor's won't take insurance. We have to pay him directly each time and then file the paperwork on our own with the insurance company.

 

[dawson5]

But is this allowed/legal, IF he is a contracted provider with my plan,and my plan states what my co-pays and fees are? That's what I have to find out.

have you spoken with your plan administrator? Sometimes it helps just to read your own before speaking with them--just so you are familiar.

From what others are saying, sounds like this might become normal. I hope not.

I would also be curious as to the people who are encountering these fees, prior to your post, how long they have been going on. Like what you are saying, basically a fee to be their patient. I am curious if this is a long running issue or something recent? Not about fees to fill out sports forms, physicals, etc.

 

[daughtersrus]

Interesting. With my insurance I have a $30 copay for the office visit, which I have to pay at the time of the visit. SOMETIMES the dr. can get additional payment, depending on how extensive the OV was, BUT they have to get the additional part from the ins. co., so they do have to file for it, since the dr. can't require me to pay more than $30.

For anything else done in the office (labs, xrays), my ins. pays 90% and I pay 10%. But they can't require me to pay the 10% until the ins. has paid the 90%. So, again, they have to file, if they want the payment.

Since they agreed to participate with my ins. co. and to be a provider, the ins. filing responsibility is on them, not me.

That is true for my insurance as well. We have a BC/BS PPO. The provider can not charge us anything until they receive an EOB showing the contractual discount as well as the payment from the insurance. Once that happens, at most we are only responsible for 20% of the discounted bill + plus or yearly deductible. (depending on the service, the insurance may pay 100%, 90% or 80%).

 

[Calliaz]

Since they agreed to participate with my ins. co. and to be a provider, the ins. filing responsibility is on them, not me.

I guess that was my point. The filing responsibility isn't just because you have insurance. It is an agreement between the insurance and the doctor and every plan is different. You don't just automatically get filing services just because you have insurance. If you are a seeing a non-preferred provider or have a different plan the requirements on the doctor may be different.

 

[angwill]

We have one doctor in town who practices as an independant doctor. He takes no insurance so if you go to him you file with them yourself. His office visits cost only $45 I wonder if these type of doctors will be happening more since they won't want to deal with the insurance companies and their rules and regulations. At least costs will come down for the doctor and patient.

 

[ReneeQ]

I spoke to a BC/BS rep this afternoon. She states as far as she can tell this fee is NOT allowed. She looked up this doctor in their system and said he did not recently re-negotiate anything (I didn't ask her to check for that, she just offered that info).

This rep was at the National BC/BS office (guess that's where the calls go when I call the customer service number). She had me on hold and was back and forth with a BC/BS rep in the Georgia office.

She asked me to fax the letter from the dr. to her, and she will investigate further, including contacting the doctor's office. She is going to call me back next week.

 

[Evi]

Personally I would begin to look for a new doctor. I've never paid any additional fees to go to the dr's office and considering they are never on time etc I wouldn't pay additional fees. I would also let the dr know your changing dr because of the fee. When enough people leave your dr will realize that some services are at his expense not your own.

 

[flamingglobessigmund]

Another Dr I go to charges


$5 if you want to use a credit card or debit card for payment

I think this is going against the credit card company's rules. The doctor can give a discount for a patient paying cash, but he/she can not impose of fee for using a credit card. Contact your credit card company and ask if this is a violation of the doctor's merchant agreement with them.

 

[fkj2]

I think this is going against the credit card company's rules. The doctor can give a discount for a patient paying cash, but he/she can not impose of fee for using a credit card. Contact your credit card company and ask if this is a violation of the doctor's merchant agreement with them.

I believe I've read of other types of businesses who are charging customers additional costs for using cards.

 

[woodsluvdis]

Crazy....I had to pay a consultation fee for my son's oral surgeon .. I was blown away when they asked for it....trust me...next time I make a consultation appt...I will ask if it cost first....

 

[HoneyPooh]

I work for a pediatrician, and we fill out ALOT of forms. Takes loads of time. We do not charge any fees for forms (yet).

My problem with this, is that a SPECIALIST is charging it. They fill out WAY less forms than the primary Drs, and get paid WAY more for a visit.......

I work in a specialist office and we have a Social Worker and two office staff who spend pretty much all day every day filling out forms that are nothing to do with office visits. FMLA forms, Medicaid eligibility forms, Records releases, records forwarding, Disability paperwork, lawsuits that patients have with their employers for workmans comp claims, you name it. Reams and reams of papers every single day. Two copiers and two fax machines are going constantly. We don't charge a dime for any of it....yet.

Oh, and we get paid a very low routine office visit payment from the insurance companies considering the specialty we are in, I have done billing for PCP's and our reimbursement is only about $20 more than theirs.

 

[A Mickeyfan]

time to find a new doctor..

 

[OceanAnnie]

I know this is about paper work fees, but I had a new one on me the other day.

I had a few questions about a bill from our Pediatrician's office. Get this, to administer a shot, not the cost of the shot, but the administration of the shot carries a fee of $25 for the first shot, and $15 for each additional shot. I had never seen this! I asked if this was new and was told no. I have never seen or heard of that. I was pretty shocked.

Have you seen this sort of fee?

 

[kelleyrn2000]

I know this is about paper work fees, but I had a new one on me the other day.

I had a few questions about a bill from our Pediatrician's office. Get this, to administer a shot, not the cost of the shot, but the administration of the shot carries a fee of $25 for the first shot, and $15 for each additional shot. I had never seen this! I asked if this was new and was told no. I have never seen or heard of that. I was pretty shocked.

Have you seen this sort of fee?

Yes, and our insurance company sent us a notice saying they will no longer cover the administration of injections except for childhood immunizations.

 

[OceanAnnie]

Yes, and our insurance company sent us a notice saying they will no longer cover the administration of injections except for childhood immunizations.

Huh. For us, this was the Pediatrician's policy, not insurance. And it was for all of the shots including childhood immunizations. Weird to me.

ETA- It took me a minute to process what you wrote. I haven't seen a break out price from the Pediatrician's office before and now that you mention it, our insurance did pay for it. I questioned it because the entries looked so out of place. It looked like we were double billed for the shots. I was actually calling about other charges. But I asked about them while I was addressing those.

 

[LovinPooh]

IMO, when places like that start getting greedy, they are only 'shooting themselves'.
start charging fees for everything, and people go elsewhere and you are left with nothing. No wonder the economy is in the toilet...

yep, find a new doctor