Extra fees for generalists

Having practiced general Internal Medicine for 33 years, I can sympathize with other physicians doing primary care in trying to
charge extra fees outside of those normally charged “to remain in practice.”

This is another instance where such physicians are shooting themselves in the foot, a transparent ploy to have patients subsidize their practices by some sort of penalty fees. Practices like these ought to be condemned in the strongest terms; they are not only unethical but tend to lend credence to the impression that physicians nowadays are more concerned with money than caring for patients.

I don’t blame insurance companies for reacting negatively to this new development. Physicians having contracts with insurance companies ought to be removed from their panels and possibly investigated by state medical boards. I dare these few buccaneer physicians to do this on Medicare patients and see what they are going to invoke for their defense.

In my home state of Florida, primary care physicians are probably paid less than those in cities like Chicago and New York.
Yet, the vast majority of them are busy and doing well, considering the high malpractice premiums here as we all know.
Few patients would believe that physicians need to charge extra money to continue practicing, particularly when the public already feels that a lot of us are overpaid.

I feel we need to be cautious about pushing this type of billing practice in our offices. Apart from being illegal, it smears us more as greedy businessmen than as altruistic physicians.

This is one more way of getting the message across to patients and insurers that they should no longer presume that the authorized payment and its deductible or copay is necessarily sufficient or satisfactory to cover their bill for services. Of course this news won’t always be welcome, but asking and expecting patients to pay their way is neither illegal nor unethical nor worthy of investigation or censure, as commentator R.G. Lacsamana seems to think.

How to go about it is the issue here. Dr. Gottlieb could continue to do as she does (assuming she isn’t breaking a contractual agreement with her patients or the insurers not to impose these “maintenance” fees) or she could dump the poor-paying or poor-performing plans, leaving those patients with the choice to pay her fees less out of plan rates or go elsewhere. Or she could just hike her rates to a level she can live with, tell her patients to pay up front, and let them wait for whatever their insurance company or the Gummint wants to give them.

The way it looks, she is leaving the decision to her patients while doing what she deems necessary to insure the survival of her practice. Whatever is wrong or unethical about that? Nothing at all, if she is disclosing her intentions to her patients. They can stick with her or walk, their choice.

Of course the insurance companies won’t like it. Who cares? The inurance companies will never want to be put in a position where their customers–the patients and their employers– will possibly regard them as chiseling float artists who are cheating both the patients and the doctors.

The harder truth is the unreasonableness of the expectation that predictable outpatient care charges should be the subject of insurance claims–the old house painting versus rebuilding argument. Of course as long as patients can get a third-party to pay their way, they will try to do so. Reintroducing the idea that routine maintenance shouldn’t be paid for by a health insurer at all is really the direction we need to be heading.