Legal Billing Fees??

[Danni R.]

You asked whether this was LEGAL; so here are my thoughts (I am also not a lawer!).

Prescriptions are typically given at office visits with enough refills until your next visit. YES


In the event a refill is needed sooner, you or your pharmacist may call us to request a refill.  We do not accept fax requests.  YES


A $10 convenience fee will be added to your account if it is approved instead of requiring an additional office visit.  “Triplicate” prescriptions also require a $10 fee and must be picked up at the office. We will not mail or call in triplicate prescriptions.  NEVER HEARD OF IT - NOT SURE - BUT PROBABLY LEGAL


If your insurance company requires a preauthorization for your medication, you have three options:
1) Discuss other options with your pharmacist that do not require a preauthorization and the pharmacist can call us to request a change. YES - OR VICE VERSA, DISCUSS WITH THE PHYSICIAN TO CALL IN GENERIC


2) Make an appointment with your doctor so he or she can block off that time to call your insurance to try to obtain approval. This office visit will require a copay. CHANGE DOCTOR


3) You may pay a $25 administrative fee to have your doctor call or fill out paperwork to try to obtain authorization. HIT DOCTOR OVER HEAD WITH A ROLLING PIN - THEN CHANGE DOCTORS

           

I guess, and I am only guessing, since rules and laws differ from state to state, that a doctor can set his own prices and fees for his OFFICE ADMINISTRATIVE services, but then again, I also know that there is such a thing as "customary and usual" fees, and I don't know where the line is, perhaps it is a gray area at best.

When I worked as a medical assistant, we had to call in prescriptions all the time, we had to sort faxes from pharmacies, pull the patient's chart (now a lot is EMR), attach the FAX and get the doctor to sign off on the refill, then call it in (or not). All was part of the normal daily routine. I do not recall ever having to keep track of this for itemized billing procedures. It was, what it was... part of the whole patient care routine.

[Steve Verno]

Many people dont understand that providers can charge for administrative fees.  State laws may stipulate that in order to charge a patient any fees in addition to that of provider care and services, the patient must be informed of these additional charges.  This allows the patient to make an informed and freedom of choice decision to continue care with that provider knowing what those fees will be and that they are responsible for paying those fees.  

Understand that I am not a lawyer and I am not providing any legal advice.  Last. no one forces us to seek care from a provider that informs us of administrative or ancillary fees.  We always have the freedom of choice to make our own decisions. 

[rashley007]

I came across this as I was looking at different Primary Care Offices Web Sites and my jaw dropped - not sure that this is legal...  What do you think?

Prescription Refills and Preauthorizations
Prescriptions are typically given at office visits with enough refills until your next visit.  In the event a refill is needed sooner, you or your pharmacist may call us to request a refill.  We do not accept fax requests.  A $10 convenience fee will be added to your account if it is approved instead of requiring an additional office visit.  “Triplicate” prescriptions also require a $10 fee and must be picked up at the office. We will not mail or call in triplicate prescriptions.  If your insurance company requires a preauthorization for your medication, you have three options:
1) Discuss other options with your pharmacist that do not require a preauthorization and the pharmacist can call us to request a change.
2) Make an appointment with your doctor so he or she can block off that time to call your insurance to try to obtain approval. This office visit will require a copay.
3) You may pay a $25 administrative fee to have your doctor call or fill out paperwork to try to obtain authorization.