Dealing with a doctor who charges for the time spent writing appeals to an insurance company can be tricky, but here’s a breakdown of the situation and some potential solutions:
Is this a common practice?
Charging for time spent on insurance appeals is not standard practice, but it does happen. Many doctors believe their time spent on administrative work, such as appeals, is not adequately compensated by insurance companies, leading them to charge patients directly. Whether this is ethical or legal depends on the doctor’s contract with the insurance company and state regulations.
Some practices include these charges in their overall administrative fees, while others may present it as a separate cost. If this fee is unexpected or feels excessive, it’s worth questioning the charge.
What can a patient do if they can’t afford it?
- Understand the Charge:
- Ask the doctor or their office to explain why they are charging for the appeal.
- Request a breakdown of the fee—how is their time calculated, and what is the hourly rate?
- Verify With Insurance:
- Contact your insurance company to see if they have rules against this practice. Some insurance plans require doctors to handle appeals as part of their contractual obligations, meaning they cannot legally charge you.
- Negotiate:
- Politely explain your financial situation to the doctor’s office and ask if the fee can be waived or reduced.
- Offer to assist with the process by drafting the appeal letter yourself. This minimizes the time the doctor has to spend on it.
- Use Advocacy Resources:
- Contact a patient advocacy organization or nonprofit that helps patients navigate insurance appeals. They may have free or low-cost services.
- Seek help from your employer’s HR department if your insurance is through work. Some companies offer advocacy support.
- Appeal on Your Own:
- With your doctor’s permission, draft the appeal yourself and ask them to review and sign it. You can find templates and guides online from trusted health advocacy websites.
- Find Pro Bono Support:
- Some healthcare systems, teaching hospitals, or nonprofit organizations provide pro bono assistance for insurance-related issues.
- Switch Providers (if feasible):
- If this practice feels unfair or causes financial hardship, consider finding another provider who does not charge for this service.
How to Prevent This in the Future
- Ask About Policies Upfront: When establishing care with a new doctor, inquire about their policy on administrative charges, including insurance appeals.
- Choose In-Network Providers: In-network providers are often contractually required to handle insurance paperwork without additional charges.
If these strategies do not resolve the issue, filing a complaint with the state medical board or your insurance commissioner’s office may be an option. Both entities oversee healthcare practices and patient rights, and they might investigate whether the charge violates regulations.
