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Remember when you only paid your doctor when you saw him? That fee covered all related administrative tasks. Getting copies of a medical record or a form signed were included free of charge.
Things are changing fast. Be prepared to cover the cost for many of these administrative services from now on.
Some billing codes accurately describe these services. Almost always, insurers reject them as “inclusive” or “not covered.” Depending on your Explanation of Benefits and based on the office policy, these fees might end up on your next statement.
- Copy of Records: Be aware that only the information is yours, not actual reports. An office may recoup their cost for paper, CD, staff time, postage, etc. In some states, this was approved by the legislature.
- Review of Records: Reviewing outside records 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 advice is not necessary in the decision-making process.
- E-visits: You may now consult a specialist out-of-state, “visit” a nutritionist or get detailed advice from your physician without ever leaving your home.
- Electronic Communications: Many offices encourage patients to go online to access electronic records, or to email requests and questions rather than calling the staff by phone.
- Handling and Supplies: “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).
- Letters/Statements: Need a jury duty excuse? A handicapped placard? Justification to avoid a trip cancellation fee? Your physician’s signed letter of medical necessity often is your only option.
- Forms: Filing an application for medical leave, disability or assistance begins with or eventually requires your physician’s assistance.
- Supplies: These charges can mean many things, including the syringe to draw your labs, the cast on your broken arm or the EKG tracing paper.
- Family Conference: The time spent educating your loved ones when facing a serious illness or intervention takes a toll on your doctor’s time and patience. Schedule a family conference for a longer appointment and for an in-depth discussion.
- Multi-physician Conference: More efficient than physician-to-physician calls, this meeting includes every medical team member involved in your care to establish individual oversight responsibilities.
What is included?
Any step necessary to perform a service is considered “inclusive” and is not payable separately. Though every step is separate, only one final product (“lab,” “infusion”) may be billed. If your consultation implies latex gloves, paper on the exam table 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.
Anything labeled as “supply” or without a specifically assigned descriptive billing code is likely included and not payable.
Should you pay?
You should not pay for any charge denied by your insurance as “inclusive.” Contact your insurer for clarification.
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 Benefits. Is the charge listed as a contractual adjustment, or as your responsibility?
Other services (letters, copy of records) fall under the discretion of each medical practice. Consult your state’s insurance department for applicable guidelines.
Sending prescriptions, requesting authorizations, filing appeals and similar administrative tasks are the office’s responsibility 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, multi-physician conferences).
Any review of records, as part of your immediate medical care, is inclusive, even if done on a different day than the actual visit.
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.
?This shift in charging patients for administrative tasks is here to stay. 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.