Are New Special Doctor's Fees Illegal?

KomoTVNews ^ | August 12, 2003 | Liz Rocca

[microgood]

SEATTLE - All of us want extra attention from our doctors, we want to get in to see them quicker, and we'd love more one-on-one time when we're sick.

Now, you can get that -- if you pay a special fee.

But now, the state is trying to figure out if that fee is legal.

Insurance paid for Meg Clara's major back surgery. But she pays extra to get extra attention from her doctor.

A monthly $25 access fee on top of her insurance premiums buys her extra perks.

"Longer appointments, more timely appointments, providing emergency care on site when needed and in the emergency room," said Dr. Brad Harris.

Dr. Harris says the fee means he can reduce his caseload and spend more time with each remaining patient.

But, when angry patients flooded the insurance commissioner with complaints, the commissioner warned doctors and insurance companies they believe the access fee is illegal.

"In some situations we have heard from patients who say I cannot afford that additional fee," said Deputy Insurance Commissioner Beth Berendt.

For the first time, the Commission met with doctors and insurance providers to encourage them to stop the practice. Insurance broker Sean Corry believes patients are being hurt.

"It creates a double standard and a double payment," he said. "I've talked to people at some of the clinics, for example, who are told they have to leave their long standing relationship with their provider because they won't or can't afford to pay the extra fee."

Doctors don't think the fee is illegal because they insist patients get extra services.

"What I want to have happen is that the system allows for us to have the opportunity to make that choice," Clara said.

Clara says if she's willing to spend the money, the insurance commission should butt out!

But if the insurance commission decides the "new access fee" is illegal, it can sue doctors and insurance companies if they don't stop charging the fee.

[microgood]

try anything new and the whole world comes down on you? Better service for a higher price, what a concept!

[Kozak]

Yeah. F'ing lawyers charge whatever the hell they want. Didn't realize when I went into medicine I gave up my rights and became a slave.

[EggsAckley]

Hmmmmm......not sure I agree with this. After paying premiums, there really shouldn't be any extra fees tacked on. Asuming, of course, they ARE paying premiums.

[Pearls Before Swine]

Better service for a higher price, what a concept!

If a good is rationed, it isn't considered "fair" to have a black-market which changes the equal portions that are rationed out. Here the assumption is that medical care quality and price are regulated and should be regulated.

There clearly isn't enough quality doctor time (almost anyone who has tried to get non-appointment service will agree--good doctors are VERY busy with paperwork as well as patients). However, its in bad form to say the "R" word and admit that the medical pricing system is so gummed up that it is effectively rationed.

[Steve Eisenberg]

After paying premiums, there really shouldn't be any extra fees tacked on.

The question to be asked is whether the people who aren't paying extra are being hurt.

Here is an example where there may be hurt: There is a family physician near me who charges a set fee of $2,000 per patient per year. These patients are encouraged to see him early in their illnesses, and often. Now, from what I read, he sometimes tries to get insurance compensation on top of this. Obviously, since his patients go to the doctor a lot, they would use their insurance a lot. Result: More money paid out to the insurers, and higher premiums.

But if there is no milking of the insurers, I am all for fee for service.

[honeygrl]

I think that's why our doctor doesn't even do the whole insurance thing. You pay it on your own and you deal with the insurance company yourself if you want to get them to cover it. He's a nice old man that hubby and I both love though so he's worth the money. Of course, if we ever needed something major we would have to find a different doctor for the procedure, but for regular stuff we can afford him. He unfortunately has cancer and is very old.. don't know what we'll do when he passes on. I can't stand most of the other doctors in town. My mom's doc is OK but if you are in a lot of pain, you are out of luck because he won't prescribe any pain med that will help much.

[Hostage]

It's not the whole story.

Many people pay hundreds of dollars each month without knowing through their employer to an insurance company.

What the Docs in Seattle are saying is:

"Pay us $250 a month direct".

That's $3000 a year and they will cover most of your contingencies in a much more responsive way. For special disabilities and developments, supplemental payments can be made.

The overhead in a doc's office in the Puget Sound is 90%, highest in the country. Reimbursements are extremely poor. More than 75% of a clinic's time and efforts are spent trying to get insurance companies to authorize care, Medicare is a Federal Gestapo medical terrorist program, Medicaid is Medicare conducted at the State level for political constituencies.

Doc's are saying they have had enough. Now they want to get some quality back into their care and into their clinics. They want to compete head on.

The State is saying that's illegal.

Look at the source, it is a local TV station. I can tell you from experience these local TV businesses are owned by families that are part of the liberal elite of Seattle and they never never get the facts straight when it comes to exposing liberal hypocrisy. The broadcast is biased to say the least.

[SC DOC]

Perhaps the price of a first class airline ticket should not cost any more than coach.

[steplock]

Premiums go to INSURANCE companies - those fees go to the doctors.

[moneyrunner]

Let's examine your premise: who are you paying your fees to, your doctor or your insurance company. And what are the terms of your contract?

[OpusatFR]

Variation on a two-tier pricing system and illegal.

[Eva]

Speaking of lawyers, I have a suggestion that might help doctors with the cost of malpractice insurance. I think that doctors that participate in a PPO should have that percentage of their malpractice insurance covered by the PPO. The PPO must already have some type of insurance since they have oversight of the treatment, so it is actually double coverage for the doctor to have to cover these patients as well.

What do you think?

[microgood]

If a good is rationed, it isn't considered "fair" to have a black-market which changes the equal portions that are rationed out.

If I was going through a set of medical problems and was constantly seeing the doctor, I would pay it just so I would not have to wait so long, etc. If, on the other hand, I only got a physical and went once in a while, I would not pay it and just wait long in the office.

I guess what the people that are complaining are saying they do not want this person to get quicker and better access because they are willing to pay for it. It seems like a kind of Rationed Mentality coming from those who have complained.

[microgood]

Perhaps the price of a first class airline ticket should not cost any more than coach.

Good analogy.

[microgood]

Didn't realize when I went into medicine I gave up my rights and became a slave.

My brother was a GP and gave it up recently. He is only 50. Spending all day Saturday doing Medicare and other paperwork did him in. And the regulations that go with it.

[Between the Lines]

A monthly $25 access fee on top of her insurance premiums buys her extra perks.

Thats a bargain!! In Charlotte doctors who do this charge upwards of $2000 a year.

[Bob]

What the Docs in Seattle are saying is:

"Pay us $250 a month direct".

From the article:

A monthly $25 access fee on top of her insurance premiums buys her extra perks.

You're off by a factor of 10. I'm not sure which way I'm leaning on this one but at $25 a month, it isn't an outrageous surcharge.

[Libertarianize the GOP]

http://www.freerepublic.com/perl/bump-list

[freedomcrusader]

Factor in also that doctor's cannot bill insurance companies for any time spent on the phone, completing charts, etc. If a lawyer thinks about your case while taking a dump, he bills it.

[Hostage]

The original story came out months ago about the straight fee for service $3000 per year.

The local news station twisted this story into some sort of copay premium or extra fee.

I have seen the local news stations get it wrong so many times. The good news is that most of Seattle knows the local news is nuts when it comes to politics.

The original story came out in the press that a group of doctors was charging differently for patients. One set of fees was for premium care and the other was a copay for insurance. So a patient could elect to pay fee for service or to be reimbursed by their isurance BUT NOT a combination fee for service and insurance reimbursement.

The original complaint was based on the premise that a doctor's practice could not separate operating expenses of one from from the orher.

Now the story has morphed in the broadcast media as an illegal surcharge.

The $25 dollar they throw out is a diversion.

[Pearls Before Swine]

I guess what the people that are complaining are saying they do not want this person to get quicker and better access because they are willing to pay for it.

Exactly. They are jealous. These people want everyone to sit at the same low level--but they are often the first to complain when THEIR treatment isn't up to snuff.

[Bob]

Thanks for the additional info. I had missed the original stories on this. I assumed (obviously incorrectly) that the facts in this article were being reported accurately.

[NautiNurse]

Variation on a two-tier pricing system and illegal.

Show me two third party payer contracts that allow the same amount for the same physician service (Blue Shield, Medicare, Medicaid, United Healthcare, CIGNA, etc.).

Several years ago, the feds gave their blessing for individual patient contracts.

[Mike Darancette]

Hmmmmm......not sure I agree with this. After paying premiums, there really shouldn't be any extra fees tacked on. Asuming, of course, they ARE paying premiums.

If the doctor works for the Insurance company or gets the premiums I would agree.

[Doc On The Bay]

--"Those Fees Go to the Doctors---"

SIGH!!

Whoever Persuaded You that the "above" statement was even APPROXIMATELY TRUE has UTTERLY "BAMBOOZLED" you!!

EXAMPLE; for a FEW Years, "Flu Shots" were NOT "Covered by" "Medicare!"

We would Give the Shots (Which we PAID FOR) for a Small, Fixed Fee (a Fee Unchanged for ~ 10 years).

A Few Years ago, Our Wonderful Federal Government Declared that the "Government" would pay for "Flu Shots!!"

The Ultimate "Bottom Line" result of our "Federal Government Authorized Flu Shots" is that Those of us, "In the Trenches," who ACTUALLY ADMINISTER "Government Mandated Health Care" NOW LOSE ~$1.00 for EVERY SHOT we Administer!!

I KNOW; Those of You Who Think "Government-Administered Healthcare" is the "Cat's Meow," Just Can't Understand why "Flu Shots" can POSSIBLY cost MORE than what the "All Wise Government" allows for them; OOPS!! "Government Mandated Allowances for the Expense of Particular Service" are OFTEN "Based on" Prehistoric Figures for costs & Expenses!!

This Office LOSES ~ $2.00/ Flu Shot!!--DESPITE the MOST SOPHISTICATED "Billing Solftware" available!!

Payments for "Medical Care" have been "Price Fixed" for Three Decades.

Services I am Legally Required to Provide to Patients for Free (or for "Rates" FAR BELOW those of Law Offices by "$/Hour") are REQUIRED BY LAW--I Either Supply Detailed Summaries of events of Which I Know Little, or I am Summoned to Court, & MUST TESTIFY "Under OATH" in Circumstances in which I CANNOT VERIFY the Physical facts of a Particular Patient's Injuries!

The Problem Is, There are still a "Few of Us" who ACTUALLY CARE about the fate of Our Patients!

There are STILL, "some of Us," who Honor the "Concept" of "Professional Integrity!!"

Most of "Us" in the "Medical Profession,"--Despite Three Decades of Professional Training & a "Deep-Seated" Respect for Those Who "are on the Front Lines" of Emergency Medical Care--are HORRIFIED BY the Mindless "Cuts" in Medical Care!

Whatever Else our Society Deems "Important," Care for our Least Fortunate & Injured has ALWAYS BEEN a "Signature Effort" of Our Culture!!

I CANNOT IMAGINE an "America" unwilling to care for the "Weak & Infirm" who come to Us for aid!!

THAT SAID, I know of NO ONE willing to grant NON-Citizens ANY "Rights!!"

"Citizenship" Involves a Potent Mix of "Rights & Responsibilities."

Most of Us Agree--Until a Person is willing to accept the Responsibilities of "Citizenship," They are NOT a "Candidate" for American Citizenship!!

No One willing to adopt "America" should be Willing to RENOUNCE ALL OTHER NATIONAL AFFILIATION, & should be able to Explain & Discuss the Declaration & the Constitution!!

For That Matter, ALL "Citizens" Ought to be able to perform the "Above Tasks" as well as--& EVEN BETTER THAN-- "Citizen'Candidates!!"

Somehow, We have Forgotten WHY AMERICA is, "SO SPECIAL!!"

Doc

[Mamzelle]

This kind of boutique medicine can be practiced--as long as your practice is exclusively boutique. Do a google on "boutique medicine"--there was an article about it in the Austin American Statesman several months ago.

[novacation]

Anything to get that third Jaquar in the driveway. As if health care providers don't make enough money to give a patient 3 minutes instead of 2. Greed

[Indrid Cold]

"The overhead in a doc's office in the Puget Sound is 90%, highest in the country."

Boo hoo. Most corporatations (like IBM) are lucky to keep 5 percent of what they earn, much less 10.

[Indrid Cold]

SPastic CAPTIALization is NOT encouraGED in modern English.

[Doc On The Bay]

The "Short Form;" I Mostly LOOSE 40cents "on the Dollar" for MANDATED "Services" I perform for our Federal Government!!

I See ~ 150 patients/week. You ask "How I Stay afloat Financially,"----"Smoke & Mirrors!!"

Despite seeing enough Patients to (Probably) remain "Afloat" Financially, I Will Eventually "Go Under!"

BY LAW, I am NOT allowed to Charge Enough for my Services to Cover my "Overhead!!"

Few Citizens Understand the TRUE status of Medical Economics.

We Are--Unfortunately,--about to Face an UNPRECEDENTED FINANCIAL DISASTER in Medical Care.

Patients are ALREADY being subjected to Suboptimal Care due to Irrational, "Money-Driven", Patient Care Decisions!

[PA Engineer]

novacation = Liberal Troll!

[honeygrl]

I am always shocked when i get statements from my insurance company showing the charges filed by then doctor and then showing what the insurance company actually paid them for the test or procedure or whatever. I seem to recall one test that was done to me (some sort of bloodwork i think) that was charge over $100 by the doctor but insurance only paid them less than $20 for it. I just don't get how they can get by paying such a low price, when someone without insurance would have to pay the over $100 price. It sounds like they are screwing us both out of money because they seem to get much more money out of us than they pay to the doctors. I also have one claim they flat out refuse to pay for because the lab filed it wrong. the lab says it was the doctors office mistake, the doctors office says it was the labs mistake and the insurance company says it was anyones fault but their own. The doctor said the test was absolutely necessary and the insurance company says it wasn't. I don't see how it's fair for them to play doctor to someone they've never even met. I personally think the test was necessary after 3 abnormal pap smears. No one wants to to take the blame for the screw up though.

[novacation]

I am neither a liberal or a troll. Doctors and hospitals charge paying patients too much to make up for the ones who don't pay.FO

[PA Engineer]

Anything to get that third Jaquar in the driveway. As if health care providers don't make enough money to give a patient 3 minutes instead of 2. Greed

Your words speak clearly enough. Only a Hillary national health care believer could come up with venom like this.

[honeygrl]

Yep, my general practitioner doesn't file any insurance forms. We just pay him out of pocket and don't bother with the insurance at all when we go to him for regular stuff we can afford. He spends as much time as it takes to deal with the problem and always takes you into his office to chat instead of the exam room once he's done with the exam. He's got to be over 70.. maybe even 75 and has cancer but still hasn't retired yet. I have yet to meet one of his patients that doesn't just adore him. He is pretty old fashioned in the way he practices medicine BUT if you have a serious problem I have heard straight from the nurses at the hospital that he is one of the best doctors to handle it in the area. He's also one of the most polite and all the nurses adore him as well. That says a lot about his character to me because I use to work at the hospital in medical records and saw how dirty a lot of the other doctors treated the nurses who had to do the dirty work. My OB/GYN isn't quite as adored by the nurses but he treats me and his other patients so well that I wonder what they do to annoy him. The L&D nurses at the hospital are pretty rude to the patients so I'm not sure I would blame him for being rude to them.

[novacation]

I support all business EXCEPT doctors and hospitals. Their prices are out of control.I don't use them, don't like the drug pushing they think they can use to solve all ills, and have had to fight more than once to get phony overcharges removed from bills. I've got an attitude about the whole system from personal experience. They don't like to listen and they really don't like to be questioned about their methods. So my view comes from a personal dislike. Nothing to do with hillary or liberals. They provide a crappy product at an inflated price. I'm just lucky I got out with my life.They're OK for broken bones and cuts, but don't have a grasp on much of what they claim as science. How many people do you know who they finished off with chemo-therapy? when I had my health problem doctor after doctor told me the same s**T. You've got to take this drug and your life is going to be f**ked. I got so fed up with them I quit going. If I had keep going they would have killed me with their BS.I recovered completly and faster without them. I just don't like them. Understand? Or are you one of the ones who looks at them as super stars?

[PA Engineer]

My wife is a doctor and I have very close first hand experience with patients such as you. You have many needs that doctors can not resolve. May I suggest you seek therapy.

[novacation]

Your wife my be a fine doctor, as far as doctors go, but you just reenforced my opinion of the arrogance of doctors.So you have first hand experience that doctors will miss mark at an alarming rate. Perfect. You have first hand experience with patients who recover, contrary to what a doctor may say. Perfect. Then you understand what I said about a crappy product at an inflated price.thanks. No insult directed towards your wife, eventhough you like send cheap shots and insults.At least you are one charactor close to health care that is cheap.

[microgood]

Any nation that destroys its most valuable citizens is doomed.

[microgood]

PA Engineer = Lawyer

[microgood]

Doctors and hospitals charge paying patients too much to make up for the ones who don't pay

The Feds have screwed up medical care beyond belief.

[novacation]

My opinion of the free medical for illegals and bums is the same as it would be for any other business. If you can't afford the product don't buy it. People have to become responible for their own expenses.The way hospitals charge is crazy. If you are a cash patient you pay the maximum if there is one.If you are an insurance or medicare pay they take what they can get. It's like going to a restaurant and having different menu prices for every different social group.It is a mess.

[microgood]

It is a mess.

The fact that they can keep the system going requires an incredible amount of innovation, which we benefit from greatly. Got to admire the ones behind the curtain.

[microgood]

PA Engineer = Lawyer

Sorry I misconstrued your position. novacation temporarily confused me. I would never accuse someone of being a lawyer that hates hillary care. I just had my messages crossed.

[OpusatFR]

With the contracts from insurance companies, yes.

But if you attempt to charge various rates for the same services you are going to find yourself in great deep....

Example, if I charge $375 for a complete physical for an insured, and charge $300 for a non-insured patient pay in the same practice, there is going to be a problem.

[Mamzelle]

re:The doctor said the test was absolutely necessary and the insurance company says it wasn't. I don't see how it's fair for them to play doctor to someone they've never even met. )))

The awful fact--even the insured are uninsured. They just haven't figured it out yet.

Another awful fact--things like pap smears ought to be paid out of pocket, and insurance kept for hospitalization and more drastic. That the expectation is strong for a third party to pay these sorts of "maintenance" health costs is like expecting a car warranty to cover an oil change.

We really could fix this. The solution is simple, but it's not easy, as Reagan said.

[quack]

Wouldn't this be the same thing as paying a retainer fee to a lawyer?

[agrace]

I absolutely agree with you. The differences between dr charges and insurance payouts is outrageous. My statements are often painful for me to look over. Either I'm getting screwed by the doctor or he/she is getting screwed by the insurance company. Guess who wins either way?

Good example of delightful insurance company practices - when my daughter was born last winter, we used our regular hospital, which according to the ins co website was a "preferred" hospital, meaning they'll pay for me to be there. When they refused to pay the bill, they said it was because the hospital was actually not preferred after all. My husband then took part in an extensive email exchange between HR in his company and the ins co, during which he cited their very own web page which clearly stated it was.

Immediately - I believe it was by the very next day, they deleted that hospital's info from the site, which we expected. But then a few days later we got a letter declining the bill again, and in it they actually had the nerve to cite the website as a resource with which to locate preferred hospitals!

We were astounded - we thought at least they would honor their "mistake" and resolve our bill. But of course not. And the audacity of actually suggesting we look online to find an appropriate hospital was incredible.

Thankfully, I know how to utilize a printer and they were busted by my husband and his HR with hard copy in hand. We were thrilled that we had beaten the big guys despite their attempts to practice utter deceit.

Then we get a letter from the ins co stating happily that the "facility has agreed to waive all charges" and the dispute was thereby resolved. So if we're not mistaken, the hospital ate every bit of the bill, even though they had absolutely no culpability in the whole mess. And so the ins co wins again.

I hate insurance companies, especially this particular monster, which seems to be everywhere, accepted by everyone, yet paying little or nothing all the time.

[honeygrl]

But that's what I pay them to cover. The only time we use our insurance nowadays is OB/GYN care and for the pediatrician. Their book says they cover 100% of OB/GYN care (with a copay at each visit) and doesn't list any exceptions. After several abnormal paps, the doc had to be sure I didn't have have anything wrong. I don't see how the insurance company could know, without being the doctor looking at the labwork and medical history, that I didn't need to be tested for problems that would cause an abnormal pap. Lucky for me, it ended up being nothing, but you can't just ignore stuff like that when you have other family members that have had cervical cancer.

[NautiNurse]

if I charge $375 for a complete physical for an insured, and charge $300 for a non-insured patient pay in the same practice, there is going to be a problem.

Not at all. You just can't charge the feds more than another payer if you are under contract with them.

Along the same lines, you can set your fees, then offer discounts for cash payment reflecting the decrease costs for billing and carrying the accounts receivable.