After a year abroad, my daughter came home last summer, unusually fatigued and with more severe asthma symptoms than when she left. After a thorough checkup, her new doctor, a family practice physician, referred us to five specialists, so I put aside a morning, and my insurance card, to make the appointments. Turns out, though, that to guarantee appointments with two of the practices, I also needed my credit card — to make a down payment on the visit.
Receptionists at those practices informed me that they would bill me upfront for a certain amount, which would be applied to any co-pay required at the time of my daughter’s visit. Any unused amount would be refunded. And if we didn’t show up for the appointment and didn’t give 24 hours’ warning, they would keep at least some of my down payment as a cancellation charge. One practice asked for $40, the other $90. And while I contemplated slamming the phone down in each case, in the end I relented to be sure that Dina, now 19, could see the doctors before heading off to her first year of college.
Consumers expect reservation agents to ask for a credit card to hold a hotel room or a table at a restaurant. But when a doctor asks for a hold fee, it feels jarring, perhaps because it turns what we think of as a healing encounter into a commercial one.
That’s exactly the point, says Kenneth Hertz, a principal at the Medical Group Management Association, a national trade association for medical practice managers. “No different than an airplane or hotel, if the appointment time comes and the patient isn’t there, that’s lost time — and revenue — forever,” Hertz says.
No one tracks the number of physician practices that require down payments, but calls to practices in the District and Maryland turned up 10 offices that either charge a hold fee in advance or require a credit card number that is billed if the patient doesn’t show up or cancels with little warning. An Internet search found scores of practices around the country, both primary-care doctors and specialists, that request a credit card number to hold an appointment.
At least 5 percent of scheduled medical appointments are missed, according to the Medical Group Management Association.
Many practice administrators say the hold fee reduces missed appointments. “It works beautifully,” says Jo Wodiska, the business manager for Reiter, Hill, Johnson & Nevin, an obstetrics practice with offices in the District, Falls Church and Chevy Chase. Wodiska says the practice she works for takes the card information but charges a $40 fee only if an appointment is missed. “Patients have the option of mailing in a check instead, which we cash only if they don’t show up or fail to cancel the appointment in time.”
Being charged after the fact for a missed appointment may be more common than being assessed a hold fee at the time of scheduling. Insurers won’t cover cancellation fees, and some plans prohibit doctors from charging their plan members with them. Call the member number on the back of your insurance card to check.
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