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#1
Old 10-25-2003, 02:32 PM
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My doctor billed me for filling out a form...would you be annoyed by this?

I'm going to be having surgery in a few weeks, and in order to have paid time off from work during my recovery (estimated at two weeks), I need to submit FMLA (Family & Medical Leave Act) paperwork to my HR department. The FMLA paperwork needs to be filled out and signed by your doctor, detailing your diagnosis, how long your recovery will be, etc.

I just got the paperwork in the mail today from my doctor's office, and it was attached to a bill for $20.00. It never occurred to me for a single second that asking for a few words and a signature would be a billable practice.

The way I see it, this falls into the same category as filing my insurance claim (he's a participating provider, so his office will handle all of the insurance claim paperwork). IMO, this is a function that their office staff should provide as part of the process of having the surgery, and I'm pretty peeved that they're going to nitpick me on a $5,000+ surgery over a $20 paperwork fee.

For those of you who have worked in medical offices...is this a standard practice? Has anyone else run across this in getting treatment from their doctor?

I'm I wrong to be annoyed?
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#2
Old 10-25-2003, 02:58 PM
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The orthopod who did my thumb has a charge for filling out paperwork. It makes perfect sense to me. Doctors make their living by charging for their time and their services. That's why quick rechecks are charged differently from more involved office visits. The dcotor is spending time providing you with a service that's above and beyond what's standard, so why wouldn't you have to pay for that time and that service?

Sure, it probably only took him fifteen minutes, but that's fifteen minutes he could have been seeing another patient (which would have billed for a lot more than $20), or doing charts, or looking at someone's films, or any of the other million little things that comprise a doctor's normal workload.

So what if he files your insurance paperwork for free? That's a courtesy, so that you don't have to pay the bill and then wait to be reimbursed. The fact that he provides one courtesy as a matter of course doesn't mean he should do extra work for free any more than the fact that a day-care offers early drop-off means they should keep your kid late for free.
#3
Old 10-25-2003, 04:37 PM
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A number of places even charge for making copies of medical records, depending on the situation and their rules.
#4
Old 10-25-2003, 05:29 PM
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My daughter needs a form about her shot record filled out for college - I fully expect a charge for that.

But, ya know, when I call and ask for a prescription refill and ask them to call it into my pharmacy, they've never charged me.

In the end, it all evens out, doesn't it?
#5
Old 10-25-2003, 06:55 PM
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My doctor, the pediatrician, pretty much any medical person we see has a charge for paperwork. The pediatrician waives it because we've gone to him for 12 years, but otherwise, the costs run from $20 - $30.

I think it's disgraceful and should be part of their professional responsibility.
#6
Old 10-25-2003, 08:16 PM
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Quote:
Originally posted by CrazyCatLady
The orthopod who did my thumb has a charge for filling out paperwork. It makes perfect sense to me. Doctors make their living by charging for their time and their services. That's why quick rechecks are charged differently from more involved office visits. The dcotor is spending time providing you with a service that's above and beyond what's standard, so why wouldn't you have to pay for that time and that service?

Sure, it probably only took him fifteen minutes, but that's fifteen minutes he could have been seeing another patient (which would have billed for a lot more than $20), or doing charts, or looking at someone's films, or any of the other million little things that comprise a doctor's normal workload.
It must work differently in different offices. I am charged exactly the same for each office visit - a copay of $10. Doesn't matter if I'm in there for an hour or for five minutes.

Second, since it's more likely the support staff and not the doctor himself or herself who is filling out the paperwork, then the doctor most certainly could be seeing another patient while it is being filled out.
#7
Old 10-25-2003, 08:18 PM
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Quote:
Originally posted by CanadianSue
I think it's disgraceful and should be part of their professional responsibility.
Oh well. Lawyers have been doing it for years. They bill for time spent on the phone with you, time spent on the phone talking to others about you, even time thinking about you and/or your case.

I got out of private practice and into public practice partly because I didn't want to have to pay so much attention to the bottom line and billing. But it's the new reality: If you want your doc to do something for you above and beyond what is involved in providing care and follow-up (sending reports to employers, governments, schools that are not for insurance purposes), be prepared to pay for it.

It costs the doctor's office in time and money to employ people to search for records. Then the doc has to grab time in between patients during a fully-booked working day to fill out a form. Then his staff has to mail/fax/file a copy. Multiply that by 20 to 30 requests a week (more in larger offices) and it adds up.

Filling out Social Security disability forms is an enormous PITA! And I've done it for patients whom I've told face to face they had no chance of getting disability based on their history and exam. But they insist, I spend sometimes up to an hour on it, then they come back and demand I resubmit it worded differently because it got rejected!
#8
Old 10-26-2003, 05:44 AM
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Quote:
Originally posted by dantheman
It must work differently in different offices. I am charged exactly the same for each office visit - a copay of $10. Doesn't matter if I'm in there for an hour or for five minutes.

Second, since it's more likely the support staff and not the doctor himself or herself who is filling out the paperwork, then the doctor most certainly could be seeing another patient while it is being filled out.
You never bother to look at what your insurance company is paying, do you? Just because your payment is always the same, that doesn't mean the total cost of the visit is the same. Ask any of the board docs, or track down our medical billing specialist MsRobyn and ask her. There are different levels of office visit, and they're each charged differently.

Regardless of who's filling out the form, the doctor is losing the time that person could be spending doing other stuff. Besides, even if support staff fills out the forms, the doctor still has to double check everything before signing it. Let's see, twenty minutes of time for a staffer who makes $10/hour to write the thing, plus another ten to fax and file it, plus five or ten minutes for the doctor to review it at $85/hour...yeah, $20 sounds about right to me.
#9
Old 10-26-2003, 05:46 AM
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Besides, Quadgop clearly fills out his own forms, and I know DrJ does his own, so obviously some docs don't get to see patients while the forms get filled out.
#10
Old 10-26-2003, 07:15 AM
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Quote:
Originally posted by CrazyCatLady
You never bother to look at what your insurance company is paying, do you? Just because your payment is always the same, that doesn't mean the total cost of the visit is the same. Ask any of the board docs, or track down our medical billing specialist MsRobyn and ask her. There are different levels of office visit, and they're each charged differently.
The point is that the cost isn't passed down to me when the visits are different, since the copay remains the same no matter what happens. I'm really not concerned if the doctor chooses to bill the insurance company. The OP was talking about being billed directly by the doctor, I thought. That seems a bit unfair.

Quote:
Regardless of who's filling out the form, the doctor is losing the time that person could be spending doing other stuff. Besides, even if support staff fills out the forms, the doctor still has to double check everything before signing it. Let's see, twenty minutes of time for a staffer who makes $10/hour to write the thing, plus another ten to fax and file it, plus five or ten minutes for the doctor to review it at $85/hour...yeah, $20 sounds about right to me.
Considering the number of patients most doctors see, I'd be very surprised if they went over the paperwork for each and every patient. This is precisely why they have their support staff. Maybe a doctor or two could confirm that.

(This would be regardomg the doctors who don't fill out their own forms.)
#11
Old 10-26-2003, 07:51 AM
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I swear, I did not do a vanity search. (Thanks, CCL!)

Dan, you pay $10 per office visit no matter what the doctor charges or the insurance pays. The doctor bills a lot more for a 5-minute visit than for a 60-minute visit (where I live, $45 for a 5-minute and about $100 for a 60-minute. This also assumes that it's a regular visit and not a consultation, for which these fees approximately double.), and the insurance companies make their payments accordingly. I'm also willing to bet that you have a higher copayment (maybe $20-25) per consultation visit.

Furthermore, filing claim forms with insurance companies is contractually required if the doctor participates with that company. This is also something that can be done electronically or at least as part of a billing software package. No doctor I've ever worked for has signed their own claim forms.

However, FMLA forms, disability certifications, motor-vehicle forms and the like aren't claim forms. They're paperwork that has to be filled out and signed by the certifying physician. Using FMLA certification as an example, some companies require detailed information and require a doctor's signature. Others are a bit more informal, but must produce appropriate documentation that, again, must be signed by a physician. Since this is paperwork that is long and detailed, it takes away from the time that a doctor can see patients, so it's certainly not unreasonable to charge a small fee to the patient for the doctor's time.

Robin
#12
Old 10-26-2003, 08:07 AM
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MsRobyn,

I've never heard of a separate copay through our provider - it's always been stated to me as a $10 fee. I hope that doesn't mean I'll be surprised some day when I get an actual consultation! Maybe it differs from provider to provider?

Examining my insurance card, I see that it says: "Encounter Fee: $10.00." Now, this could just mean that the typical "encounter" is $10 and that consultations and the like are more money. It might be in the fine print in the myriad forms I filled out when signing up.

Now, if the doctor participates with a particular insurance carrier and is contractually obligated to fill out forms for that carrier on behalf of the patient, they shouldn't be passing along a fee to me, from what I can tell - unless they fall under the categories you've mentioned.

It seems to me that the charging of filling out the forms is an exception to the rule, not the rule itself; that is, if the doctor himself or herself has to do it. That does seem fair.

I hope I have it right now. Thanks for the answer, MsRobyn.
#13
Old 10-26-2003, 09:11 AM
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On re-reading my post, I can see that I wasn't clear.

The paperwork Jadis described and insurance paperwork are apples and oranges. Doctors may be contractually obligated to file insurance paperwork, which includes claim forms, fulfilling certain records requests, and that sort of thing. However, FMLA paperwork, disability/SSI paperwork, DMV paperwork, and similar forms are not an issue with the patient's insurance company. The insurers don't have a dog in that fight, so to speak. Because these forms take a long time to gather appropriate information, fill out, and return, it's not unreasonable to charge the patient directly for the "courtesy" of filling out these forms.

I hope that makes more sense.

Robin
#14
Old 10-26-2003, 09:15 AM
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Yes, it is. I'm a clueless patient, and I don't know what the insurance company does, other than bill people. (I'm being a little facetious, of course.)

I think it's likely I'll never be charged for my doctor's filling out a form unless it's an unusual form that doesn't go through the insurance company. So like I said, the exception rather than the rule. Whew!
#15
Old 10-26-2003, 09:43 AM
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I'd send the bill back with a note that said "Not fucking likely" attached to it. Then be hunting me up a new doctor.
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#16
Old 10-26-2003, 12:56 PM
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See, that's the kind of attitude that's caused my orthopod to have big yellow signs in every exam room stating that before filling out extra forms for you, you have to a)already have paid your $20 fee, and b) have already filled out your part of the form. In the OP's case, she could refuse to pay it, but they'd turn her over to collections after a few months.
#17
Old 10-26-2003, 01:35 PM
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I should also point out that some of these forms are quite detailed and require a lot of information either on the form, or attached to it. For example, disability forms can be quite detailed and involve a lot of time and effort on the doctor's part to fill out. It can take anywhere to 30 to 60 minutes or longer, depending on what's required. That time is time that would otherwise generate income in the form of seeing patients. Since the physician obviously can't see patients while he's doing paperwork, there is a charge tacked on. You wouldn't expect a lawyer or mechanic take work on for free, so why would you expect a doctor to do the same?

The sad and boring truth is that doctors are businessmen, too. They're responsible for supporting their own families, but nurses, assistants, billing staff, etc. For every patient they don't see, that's money they don't make. Some doctors do a lot of extra paperwork at the patient's request. These doctors lose money by doing this paperwork. So, some of them have a small charge to do it, and it's a legitimate charge. You're free not to pay it, of course, but you're also going to be sent to collections over it.

Or, you could think of it this way: You can leave your paperwork there, have the doctor fill it out, and your doctor can charge $20 for the service OR you can schedule an office visit, stare at the walls while he fills it out, and pay $60 (non-reimbursable by the insurance company) for the privilege.

The choice is yours.

Robin
#18
Old 10-26-2003, 01:49 PM
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Quote:
Originally posted by dantheman
I think it's likely I'll never be charged for my doctor's filling out a form unless it's an unusual form that doesn't go through the insurance company. So like I said, the exception rather than the rule. Whew!
There are plenty of non-insurance forms that go thru a physician's office, that need a physician's attention. MsRobyn listed a number such as SSI disability, FMLA, DMV, etc. There's tons more. And they generally require that the physician fill out the key parts. I've spent lots of time combing thru charts trying to sort out the proper labs, tests, responses to treatments, etc. And the failure of which to document in the order that the people wanting the form want to see it will result in them disallowing it and sending it back. It's a lot of work, it's not part of my treatment plan for the patient, it doesn't involve reimbursement for my office, and the core data on it can't be delegated to support staff.

Frankly, I'm glad to be out of the whole fee-for-service business. Because I saw a time coming when I'd be expected to see patients 8 hours a day to generate revenue, then spend 3-4 hours a day finishing paperwork.
#19
Old 10-26-2003, 01:50 PM
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Not only that, but even though doctors aren't usually struggling, their malpractice insurance is almost always very expensive.
#20
Old 10-26-2003, 02:12 PM
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Oops, my post was responding to MsRobyn, not Dr. Mercotan.

(I guess I've been fortunate so far in not having to pay for a form to be filled out.)
#21
Old 10-26-2003, 07:40 PM
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I don't know about the other forms that you're all talking about, but when I say that my FMLA forms have approximately 20 words *total* written on them, including all of the sections marked "N/A', I'm not exaggerating. And the doctor's name, office address and signature are stamped on, not even hand written.

So, yeah...I'm still pissed about the $20, especially in light of the fact that he's going to be collecting a $5,000 (or more) fee for this surgery. IMO, filling out a form should be part and parcel of the service he's going to provide for that $5k.
#22
Old 10-26-2003, 10:43 PM
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I didn't realize how widespread this practice was, but I've thought ever since I started this game that it would be a good idea.

I have my own clinic once a week; it's very small and I probably see half as many patients in that time that a private doctor would see. I probably spend an hour on each of those days doing paperwork on patients other than those I've seen that day. Forms to be filled out, labs to be reviewed, phone calls to be made, problems that my patients didn't want to come in with, problems with patients getting medications, and on and on.

I really, really hate filling out forms. Their purpose is usually for me to certify that the patient has met some byzantine set of criteria in order to qualify for the insurance company to pay for, say, their insulin. The patient never has his part filled out, and they're never given to me with any explanation; it's just, "Here, I think you're supposed to do something with this." It often takes some time to figure out just what the point of the form is, long before I have to start digging in the chart to document three years of the patient's oxygen saturations.

You're going to see more of this--charges for paperwork, charges for prescription refills, charges for phone calls. Our clinic has a full-time RN who does nothing but take phone calls, and about half of her time is spent dealing with refills from patients who forgot to get something refilled at their last visit, or who haven't had a visit since the refills ran out, or some such. As these things take up more and more time, the only alternative to charging for them would be to raise fees for office visits and procedures, and the insurance companies aren't going to go for that.

All that said, I think it's only fair to make this very clear to you before filling out the paperwork and assessing the fee, like the big yellow signs in CCL's orthopod's office.

Dr. J
#23
Old 10-26-2003, 10:57 PM
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20 bucks, huh? Sounds like you got off easy.
#24
Old 10-26-2003, 11:06 PM
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Re: My doctor billed me for filling out a form...would you be annoyed by this?

Quote:
Originally posted by Jadis
IMO, this is a function that their office staff should provide as part of the process of having the surgery, and I'm pretty peeved that they're going to nitpick me on a $5,000+ surgery over a $20 paperwork fee.
They might wonder why you're peeved about a measly $20 on top of $5,000+. It seems fair to me to charge you. The paperwork was filled out as a professional service, and it required the signature of a doctor, not just any old Joe Schmo. It reminds me of that anecdote about a guy who asks his lawyer to write a legal notice, and gets a bill for $5,000. He is outraged, and then his lawyer gives him the following billing breakdown: "$5 to write the letter, $4,995 for knowing what to put in the letter."
#25
Old 10-27-2003, 12:07 AM
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Quote:
Originally posted by Jadis
So, yeah...I'm still pissed about the $20, especially in light of the fact that he's going to be collecting a $5,000 (or more) fee for this surgery. IMO, filling out a form should be part and parcel of the service he's going to provide for that $5k.
Other patients getting the same surgery for the same price don't also need that form filled out.

That form has nothing to do with the surgery, or even the billing for the surgery. There is nothing in the physician's self-interest related to that form. It has only to do with a PERSONAL benefit for YOU.

Never a fee before for filling out a form? Irrelevant. Things change -- what was right in the past isn't necessarily right now. Heck, it may not have been right then.

Form is short and can't take that long to fill out? Irrelevant. There's likely a minimum fee for dealing with a form. And the doc assumes some responsibility, and thus incurs some risk, any time he's signs such a thing. It's not a charge-by-the-hour or charge-by-the-word situation (although longer/bigger PITA forms warrant higher fees than short easy ones).
#26
Old 10-27-2003, 12:14 AM
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Quote:
Originally posted by Krisfer the Cat
I'd send the bill back with a note that said "Not fucking likely" attached to it. Then be hunting me up a new doctor.
Don't be surprised to find other doctors "aren't accepting new patients." Not many people are interested in clients who want to dictate their billing policy to them.
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