Cover Story

Nonbillables: When should patients pay for them?

A debate is raging among physicians about whether to charge patients for services that payers don't cover.

By Ken Terry
Senior Editor

Although many say they'd like to, only a small minority of doctors are charging patients for things like phone calls and photo copying that third-party payers don't reimburse them for.

Bernd Wollschlaeger, a family physician in North Miami Beach, FL, is one of them. He charges $25-$35 for a phone consultation or e-mail consult, $10 for a phoned-in prescription refill, $25-$40 for completing a form, and 50 cents a page for copying records.

Wollschlaeger established this policy about a year and a half ago. "I was upset about the freebies I had to render on a daily basis, which took a lot of time away from patient care. I found it abusive. I had to figure out a way to compensate for the time that I was spending."

About 80 percent of his patients accepted the new policy without question, he says. The rest grumbled, but nobody has left the practice so far.

FP David Bright of Stuart, FL, is thinking about charging for nonbillable services, but he hasn't done it yet. With his costs rising and his revenues stagnant, he expects he'll eventually start losing money unless he can see more patients or find new sources of income. He's concerned, however, about patients leaving if he begins billing them for phone care and other extra services. "It's hard to be out in front. But if you don't do it, you'll slowly starve to death."

In between Wollschlaeger and Bright are many doctors who've started to charge for some "freebies"—usually copying records and filling out forms. Most who've tried billing for phone consults have backed off it because of patient opposition. But physicians have found that some patients are willing to pay for e-mail access, perhaps because it's new and suits their lifestyles.