In today's snailmail I received a letter from my primary care physican that
said:

__________________________________________________ ___

Dear Patient:

<first, some stuff that basically says that costs are going up due to
federal regulations, the cost of dealing with insurance companies, and so
forth >

Therefore, effective March 1, 2005, we will be collecting an office
surcharge of $25 annually per patient, payable at the time of your first
visit in the calendar year.

<more stuff that says we are sorry and we hope that you understand>

Sincerely,

(Signatures of the six physicians in the practice)
__________________________________________________ ___

I already pay $2500 per year, in addition to what my employer (a large
county government) pays, for PPO medical and hospitalization insurance for
my family of 2 healthy adults and 3 healthy children. I don't have
prescription coverage.

I pay a $10 per visit copayment to the doctor, and the insurance company
pays the rest, typically an additional $35 to $100, depending upon what is
done. I'm not sure, but I think that my doctor gets a small monthly fee
from the insurance company just because I listed him as my primary care
provider, even if I never call or see him. (This is called "capitation", I
believe.)

Note that this $25 is NOT for the "concierge service" that some doctors are
now offering as an option. This is a mandatory $25 per patient, per year
fee, waived only if you don't see the doctor at all during a particular
calendar year.

For what it's worth, my family is not a big user of medical services. Maybe
one visit per year per person to the doctor, if that.

My questions are:

Is this additional charge legal? After all, my insurance policy says that I
have to pay a $10 copayment per visit. It doesn't say anything about
allowing the doctor to charge additional overhead fees.

Anyone else have any experience with this type of surcharge? Did you
complain to anyone (doctor, insurance company, attorney general, insurance
regulator, etc.) about it? What was the outcome?

And, yes, I do realize that I also have the option to change doctors if I
don't want to pay the fee. I also have the option of bypassing my primary
care doctor entirely, as my plan is "open access" and therefore does not
require referrals to specialists. But that seems rather wasteful.

Please post replies to this group. (Please do not try to apply to my email
address.) Thanks!

gps
390

Patient wrote: In today's snailmail I received a letter from my primary care physican that said: __________________________________________________ ___ Dear Patient: <first, some stuff that basically says that costs are going up due to federal regulations, the cost of dealing with insurance companies, and so forth > Therefore, effective March 1, 2005, we will be collecting an office surcharge of $25 annually per patient, payable at the time of your first visit in the calendar year. <more stuff that says we are sorry and we hope that you understand> Sincerely, (Signatures of the six physicians in the practice) __________________________________________________ ___ I already pay $2500 per year, in addition to what my employer (a large county government) pays, for PPO medical and hospitalization insurance for my family of 2 healthy adults and 3 healthy children. I don't have prescription coverage. I pay a $10 per visit copayment to the doctor, and the insurance company pays the rest, typically an additional $35 to $100, depending upon what is done. I'm not sure, but I think that my doctor gets a small monthly fee from the insurance company just because I listed him as my primary care provider, even if I never call or see him. (This is called "capitation", I believe.) Note that this $25 is NOT for the "concierge service" that some doctors are now offering as an option. This is a mandatory $25 per patient, per year fee, waived only if you don't see the doctor at all during a particular calendar year. For what it's worth, my family is not a big user of medical services. Maybe one visit per year per person to the doctor, if that. My questions are: Is this additional charge legal? After all, my insurance policy says that I have to pay a $10 copayment per visit. It doesn't say anything about allowing the doctor to charge additional overhead fees. Anyone else have any experience with this type of surcharge? Did you complain to anyone (doctor, insurance company, attorney general, insurance regulator, etc.) about it? What was the outcome? And, yes, I do realize that I also have the option to change doctors if I don't want to pay the fee. I also have the option of bypassing my primary care doctor entirely, as my plan is "open access" and therefore does not require referrals to specialists. But that seems rather wasteful. Please post replies to this group. (Please do not try to apply to my email address.) Thanks! gps 390
Of course it's legal. The question is whether the Drs are violating any
provisions of the contract that they have with your PPO. Check with your
insurer.

/dan

In article <MtK2e.67$tr1.800@news.uswest.net>,
"Patient" <patient@mailinator.com> wrote:
ne visit per year per person to the doctor, if that. My questions are: Is this additional charge legal? After all, my insurance policy says that I have to pay a $10 copayment per visit. It doesn't say anything about allowing the doctor to charge additional overhead fees. Anyone else have any experience with this type of surcharge? Did you complain to anyone (doctor, insurance company, attorney general, insurance regulator, etc.) about it? What was the outcome? And, yes, I do realize that I also have the option to change doctors if I don't want to pay the fee. I also have the option of bypassing my primary care doctor entirely, as my plan is "open access" and therefore does not require referrals to specialists. But that seems rather wasteful. Please post replies to this group. (Please do not try to apply to my email address.) Thanks!

Legality depends on the laws in your state. For an authoritative answer,
contact your state's consumer affairs office or insurance commissioner
to ask for advise. You can probably find the contact information for
these departments on your state's web site. You might also try
contacting your employer's benefits department and maybe your medical
insurance provider.

"Dan Ganek" <degspam@comcast.net> wrote in message
news:lo-dnZeFNrrd6NbfRVn-gA@comcast.com... Of course it's legal. The question is whether the Drs are violating any provisions of the contract that they have with your PPO. Check with your insurer.

If the doctor was in violation of a contract... wouldn't that be an illegal
act?

Hello,
You wrote on Wed, 30 Mar 2005 22:52:00 -0500:

P> Therefore, effective March 1, 2005, we will be collecting an office
P> surcharge of $25 annually per patient, payable at the time of your first
P> visit in the calendar year.
....
P> Is this additional charge legal?

No. Tell your insurance about it.

regards.

Todd,

Violating a contract is not necessarily an illegal act. Dan's answer is
quite correct this is a civil not a criminal matter, The OP should contact
his insurer about this new fee.

Dave M.

On Thu, 31 Mar 2005 12:18:43 GMT, "Todd Copeland"
<todd@copelandhome.net> wrote:
"Dan Ganek" <degspam@comcast.net> wrote in messagenews:lo-dnZeFNrrd6NbfRVn-gA@comcast.com... Of course it's legal. The question is whether the Drs are violating any provisions of the contract that they have with your PPO. Check with your insurer.If the doctor was in violation of a contract... wouldn't that be an illegalact?
No, that would be a civil matter, not an illegal act.

On Thu, 31 Mar 2005 16:57:55 GMT, Bob Ward <bobward@verizon.net>
wrote:
On Thu, 31 Mar 2005 12:18:43 GMT, "Todd Copeland"<todd@copelandhome.net> wrote:"Dan Ganek" <degspam@comcast.net> wrote in messagenews:lo-dnZeFNrrd6NbfRVn-gA@comcast.com... Of course it's legal. The question is whether the Drs are violating any provisions of the contract that they have with your PPO. Check with your insurer.If the doctor was in violation of a contract... wouldn't that be an illegalact?No, that would be a civil matter, not an illegal act.


That depends on a number of things. Is he for example taking this fee
from meidcaid and medicare patients in violation of the law?

On Thu, 31 Mar 2005 09:55:41 -0800, retrogrouch@comcast.net wrote:
On Thu, 31 Mar 2005 16:57:55 GMT, Bob Ward <bobward@verizon.net>wrote:On Thu, 31 Mar 2005 12:18:43 GMT, "Todd Copeland"<todd@copelandhome.net> wrote:"Dan Ganek" <degspam@comcast.net> wrote in messagenews:lo-dnZeFNrrd6NbfRVn-gA@comcast.com...> Of course it's legal. The question is whether the Drs are violating any> provisions of the contract that they have with your PPO. Check with your> insurer.If the doctor was in violation of a contract... wouldn't that be an illegalact?No, that would be a civil matter, not an illegal act.That depends on a number of things. Is he for example taking this feefrom meidcaid and medicare patients in violation of the law?


My response was in direct reply to the question of whether or not the
doctor's being in violation of a civil contract would be an illegal
act. It has nothing at all to do with your speculation on an entirely
different matter.

"Patient" <patient@mailinator.com> wrote in message
news:MtK2e.67$tr1.800@news.uswest.net...
Note that this $25 is NOT for the "concierge service" that some doctors
are


what's concierge service?

AllEmailDeletedImmediately wrote: "Patient" <patient@mailinator.com> wrote: Note that this $25 is NOT for the "concierge service" that some doctors are what's concierge service?

Getting your suit pressed, getting dinner reservations or theater tickets,
ordering a taxi, calling a hooker...

--
Cheers, Bev
-------------------------------------------------------------------
"There is nothing wrong with it and I didn't do it and, my gosh,
well I guess I just remembered I did...sort of...but it wasn't my
fault...because my staff didn't tell me...and I was very busy
meditating on the issues and besides I thought I was in Cleveland."
-- Meg Greenfield

"AllEmailDeletedImmediately" <derjda@hotmail.com> wrote in message
news:jdZ2e.503$bI3.51020@monger.newsread.com... "Patient" <patient@mailinator.com> wrote in message news:MtK2e.67$tr1.800@news.uswest.net... Note that this $25 is NOT for the "concierge service" that some doctors are what's concierge service?

Concierge service, in the context of the medical industry, is where you pay
a doctor a yearly fee that gives you premium access to the doctor and
special respect from the staff. The fee varies widely but is typically
between about $1000 to $5000 per year. The concierge service fee is in
addition to the usual fees paid by you or your insurance company for the
actual medical services.

Here are links to a few articles about physican concierge service:

http://www.physiciansnews.com/business/204.kalogredis.html

http://www.hansonbridgett.com/newsletters/PhysicianLawAlert/PhyslawalertSept02.html

http://www.msnbc.msn.com/id/6885323/site/newsweek/

<retrogrouch@comcast.net> wrote in message
news:ubeo41l3gpf5gk9nm8tjhsgb6r02d5jmhp@4ax.com... On Thu, 31 Mar 2005 16:57:55 GMT, Bob Ward <bobward@verizon.net> wrote: That depends on a number of things. Is he for example taking this fee from meidcaid and medicare patients in violation of the law?

Thanks for all of the replies, and especially for pointing out the special
case of medicare and medicaid. I will check with the doctor to determine
their policy for charging the additional fee to medicare patients, as that
would appear to be a violation of federal law.

I spoke with the manager of the medical billing investigation unit at the
Office of the Attorney General of Maryland today, and to my surprise, he was
already familiar with the letter that I had received because a number of
complaints had been received by his office by other patients of the medical
practice.

Since an OAG investigation is now underway, it's probably better for me to
not post any more details at this time. However, if anyone else in Maryland
wants to submit a complaint, the complaint form at
http://www.oag.state.md.us/Forms/HEAUcompl.pdf should be completed and
mailed to the attention of Mr. Dean Muscello at the address on the top of
the complaint form.

Thanks again for everyone's replies.

Patient wrote: In today's snailmail I received a letter from my primary care physican that said: __________________________________________________ ___ Dear Patient: <first, some stuff that basically says that costs are going up due to federal regulations, the cost of dealing with insurance companies, and so forth > Therefore, effective March 1, 2005, we will be collecting an office surcharge of $25 annually per patient, payable at the time of your first visit in the calendar year. <more stuff that says we are sorry and we hope that you understand> Sincerely, (Signatures of the six physicians in the practice) __________________________________________________ ___ I already pay $2500 per year, in addition to what my employer (a large county government) pays, for PPO medical and hospitalization insurance for my family of 2 healthy adults and 3 healthy children. I don't have prescription coverage. I pay a $10 per visit copayment to the doctor, and the insurance company pays the rest, typically an additional $35 to $100, depending upon what is done. I'm not sure, but I think that my doctor gets a small monthly fee from the insurance company just because I listed him as my primary care provider, even if I never call or see him. (This is called "capitation", I believe.) Note that this $25 is NOT for the "concierge service" that some doctors are now offering as an option. This is a mandatory $25 per patient, per year fee, waived only if you don't see the doctor at all during a particular calendar year. For what it's worth, my family is not a big user of medical services. Maybe one visit per year per person to the doctor, if that. My questions are: Is this additional charge legal? After all, my insurance policy says that I have to pay a $10 copayment per visit. It doesn't say anything about allowing the doctor to charge additional overhead fees. Anyone else have any experience with this type of surcharge? Did you complain to anyone (doctor, insurance company, attorney general, insurance regulator, etc.) about it? What was the outcome? And, yes, I do realize that I also have the option to change doctors if I don't want to pay the fee. I also have the option of bypassing my primary care doctor entirely, as my plan is "open access" and therefore does not require referrals to specialists. But that seems rather wasteful. Please post replies to this group. (Please do not try to apply to my email address.) Thanks! gps 390

When I saw "Maryland" in your headers I immediately knew
about this -- from recent publicity. This $25 fee is being
charged to help the doctors pay for their "outrageous"
malpractice insurance premiums. Some doctors have threatened
to close their office and move to another state, if legislation
(in their favor) isn't soon passed.

KM

Patient wrote: In today's snailmail I received a letter from my primary care physican that said: Is this additional charge legal? After all, my insurance policy says that I have to pay a $10 copayment per visit. It doesn't say anything about allowing the doctor to charge additional overhead fees. Anyone else have any experience with this type of surcharge? Did you complain to anyone (doctor, insurance company, attorney general, insurance regulator, etc.) about it? What was the outcome? And, yes, I do realize that I also have the option to change doctors if I don't want to pay the fee. I also have the option of bypassing my primary care doctor entirely, as my plan is "open access" and therefore does not require referrals to specialists. But that seems rather wasteful.

Relative to insurance companies...sure it's legal, in that no laws are being
broken. It might be in violation of that office's contract with your
insurance company, if they have one, however, and you'll have to check with
them about that. Medicare/Medicaid, OTOH, is more of a grey area and the
"legality" would depend on how they word the rationale for the $25 fee. If
they notified a Medicare patient that the $25 fee was to cover the cost of
parking, for example, then it may fly.

HMc