Beause of the economic pressures of the past several years, banks, airlines, cellphone carriers and a host of other businesses have begun tacking on fees for assorted services that were once free, notes Orly Avitzur, medical adviser to Consumer Reports. Now medical practices, hospitals, radiology facilities and other health-care providers are getting into the act.
Health insurance plans usually have reimbursement guidelines for all covered services, such as office visits. But most plans also allow doctors to charge patients for certain nonmedical services, such as administrative fees, that aren’t covered. Because they entail out-of-pocket costs for patients, most insurers require doctors to notify you of such charges ahead of time. Indeed, some companies insist on your written acknowledgment that the additional fees are your responsibility.
So which of those extras can doctors charge for? To get the legal lowdown, Avitzur consulted Daniel B. Brown, a health-care attorney in Atlanta.
Can I be required to pay a fee for copies of my health records?
Yes. Federal law and laws in most states authorize doctors to charge reasonable fees for photocopying. The Health Insurance Portability and Accountability Act also allows all providers covered by it to charge a “reasonable, cost-based fee” for making protected health information available to a patient or the patient’s representatives. The charges may include costs for photocopying and the labor it requires, supplies, postage and preparing a summary — rather than a full record — of a patient’s history. Ditto for fees for pulling charts and filling out forms for camp and school physicals, and for forms relating to disability, returning to work, gym releases and family medical leave. One caveat: It’s unethical for a doctor to withhold a patient’s medical records because of an unpaid balance.
Can I be charged for telephone calls and e-mail from my doctor?
No, not as a general rule. When insurance, including Medicare, pays for a visit or a service, follow-up by phone or e-mail is considered part of the original, face-to-face service and therefore isn’t reimbursed to your doctor. On the other hand, if you were to phone your doctor several months after your last visit about an unrelated issue, he could charge you for the call as an independent service. Under those circumstances, you might be billed directly. Medicare suggests that doctors advise patients of those charges in advance.
What if my doctor spends extra time on my care? Can she bill for that?
No. In fact, doctors often spend as much as 20 hours per week responding to requests from health-insurance companies for authorization of certain medications they’ve prescribed, as well as many other kinds of documentation. Even so, Medicare and private payers strictly prohibit them from charging for those services or for extra time spent doing research or caring for patients. Doing so is considered double-dipping.
Can my doctor charge me if I don’t show up for an appointment?
Yes. Around the country, rates for no-shows range from 5 percent to 55 percent, an inconvenience that has prompted many practices — with the blessing of Medicare and other insurance plans — to set policies that allow them to charge a patient who fails to cancel a scheduled appointment within a specified time (usually 24 hours in advance). In fact, many doctors whom Avitzur knows now request credit-card information before the first visit and notify new patients of the no-show policy, encouraging them to call, send an e-mail or go online to cancel if they’re unable to keep the appointment. Medicare specifically states that the fee is meant to cover a doctor’s missed business opportunities, but doctors can charge it only if the policy applies to all patients, Medicare and non-Medicare alike.
For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.