Patient Advocacy: Healthcare on your side
by Martine G. Brousse,
Healthcare
Specialist, Patient Advocate, Certified Mediator
ADVIMEDPRO
Ten Services Your Physician
might soon bill you for*
Ten Services Your Physician
might soon bill you for*
In the
"olden" days, which are actually not that far behind us, patients
paid their co-pay at the window at each office visit, and would receive a bill
for any balance owed later.
All administrative tasks were covered under that visit payment. Getting a copy of records was free, as was getting a form signed.
Things have changed. Be prepared to be asked to pay for certain of those "non face-to-face" services. Almost always, they are rejected as "inclusive" or
"not covered" by insurances. Depending on the insurance Explanation of Benefit and on the medical practice's policy, these
fees might be reflected on your next statement.
A. What are some of those charges?
1.Copy of Records:
Although records are about you, be aware that only the information is yours, not
the actual reports. It is widely accepted that an office may recoup the cost for paper, CD, staff time, postage, etc. In some
states, this was approved by the legislature and fees have been set.
2. Review of Records:
Reviewing
outside records or of your updated medication list is part of the visit with your physician to establish a
diagnosis or prescribe the right treatment. More unclear is the status of reports sent by satellite medical providers or
therapists whose advise is not necessary in the decision making process.
3. E-visits:
Telemedicine visits
are up.
4. Electronic Communications
Many
offices encourage patients to use a web portal to directly access Electronic
Records or email requests and questions rather than calling the staff.
5.
Handling
"Handling",
commonly seen on statements, reflects the extra "stuff" the office
personnel has to do to complete a doctor's order (process blood samples, call
prescriptions in, send samples to an outside lab, discard fluids securely,
sanitize equipment). Insurers never pay those extras, as they are part of the main service.
6. Letters (of Medical Necessity) and Statements
Need
a Jury Duty excuse? A handicapped placard? Justification to avoid a trip cancellation
fee? Your physicians' signed letter of medical necessity often is your only
recourse.
7. Forms & Applications
If filing for medical leave, disability, or apply for benefits, the process either begins with or
eventually requires your physician's assistance.
Applying for
assistance programs from drug manufacturers or charitable organizations will
also result in questionnaires on your MD's desk.
8. Supplies
These charges can
mean anything: the syringe used to draw your labs, the cast
on your broken arm, the IV tubing for your
infusion. Only some are included in the cost of the service.
9. Family Conference
The
time spent educating your loved ones when facing a serious illness or
intervention takes a toll on your MD's patience and time.
Scheduling a family conference for a longer-timed appointment allows for an unhurried discussion.
10.
Multi-physician Conference
More
efficient than physician-to-physician calls, this conference gathers every
medical team member involved in your care to establish individual oversight responsibilities and discuss your ongoing care.
B. What is included and what is not?
Any
step necessary to perform or complete a doctor's order is considered "inclusive" and is
not payable separately. Though
every step is separate, only one final product ("lab", "infusion")
may be billed.
If
the office visit implies latex gloves, paper on the exam table, the review of your medications or a Band-Aid,
these are inclusive to the visit.
Anything
"extra" such as medications or durable medical equipment (implantable
pump, cast) is payable in addition to the base service. So is the use of
specific equipment (imaging, EKG).
You
can be billed for the use of the X-ray machine plus the fee of the doctor
reading the results, but the cost of the film is inclusive.
In general,
anything labeled as "supply" or without a specifically assigned
descriptive billing code is likely included in the global fee.
C. Should I pay?
Maybe.
Certain fees such as
handling, many supplies, electronic transmissions are not your responsibility. You
should not pay for any charge that your insurance has rejected as
"inclusive".
If
charges are denied as "not a covered benefit", or if you are a
self-pay patient, the office might bill you. Check your Explanation of Benefit:
is the charge listed as a contractual adjustment, or as your responsibility?
Other services
(letters, applications and copy of records) fall under the discretion of each
medical practice. Consult your State's Insurance Commissioner's
Office on the applicable guidelines and on your rights.
Sending
prescriptions or approving refills, requesting authorizations, filing appeals,
and other similar administrative or billing tasks are the responsibility of your physician
and may not be billed to you.
Services
requiring the actual involvement and expertise of your physician should be paid
by you, even if your insurance does not (e-visit, family conferences). Most offices will schedule them as a "cash only"
appointment. You should pay them.
As for for
multi-physician conferences, they should be reimbursed by your insurance, or by you
in the alternative.
Any
review of records, as part of your immediate medical care, is inclusive, even
if done on a different day than the actual visit.
If asking
your doctor to comment on an article you
found on the internet, expect to be asked for a fee in the near future. Unless they
are necessary for the MD to perform his duties or for your safety to be
safeguarded, you are hiring her for a side job and should be prepared to
compensate her for that time.
Some costs (i.e. e-visits) might be deductible as a medical expense on your
tax return or be eligible under your HSA or FSA account, even when denied by
your insurer.
Please
visit http://www.irs.gov/pub/irs-pdf/p502.pdf
for detailed info.
D. In conclusion:
This shift in
charging patients for office staff or inclusive services is likely to grow. Pressure is mounting on insurers to reimburse some of services (e-visits especially).
Until the healthcare system in
flux stabilizes, expect to be hit for services previously free of charge. While some fees are justified, many are not.
Your
explanation of Benefits is your road map. But you may not want to argue every
charge. Just as you do not
work for free, neither should your physician.
© [2016] Advimedpro.
© [2016] Martine G. Brousse.
All rights reserved.
My
objective is to offer you, the patient, concrete and beneficial
information, useful tips, proven and efficient tools as well as
trustworthy supportive advice as you deal with a system in the midst of sweeping adjustments, widespread misunderstandings and complex requirements.
AdvimedPro (424) 999 4705 or (877) 658 9446 fax (424) 226 1330
