Some Maryland doctors are urging patients to pay an extra administrative fee to finance services that health insurers will not cover.
The Maryland Attorney General’s Office is examining the legality of the surcharges, which run $15 and higher annually.
“In our opinion, such a charge violates the state HMO law’s prohibition against balance billing of HMO members,” the Maryland Attorney General’s Office said in a January opinion.
By law, Maryland patients with insurance plans such as health maintenance organizations (HMO) are not required to pay a malpractice or administrative surcharge.
The agency, which investigates consumer complaints, has received three to four complaints about the surcharges, said Assistant Attorney General Ellen Kuhn.
The complaints are in mediation, Ms. Kuhn said, who would not disclose further details, saying only, “We are continuing to monitor this situation.”
Drs. Esposito, Mayer, Hogan and Associates PA, a Columbia, Md., obstetrics/gynecology practice, in May began asking for a $25-per-patient annual fee.
“Recently, medical malpractice rates have skyrocketed out of control and will have a major impact on our practice, as well as on all medical practices in the state of Maryland,” the practice said in a letter informing patients of the surcharge.
“Facing this reality and after careful consideration, we have concluded that we will institute a fee of $25 per patient per year to help meet our increasing administrative costs,” the letter said.
Executive Director Steve Flury said the fee is voluntary and not applicable to patients on government insurance programs such as Medicare and Medicaid.
The practice will not turn away patients who refuse to pay the extra charge, he said.
“None of our patients have stopped seeking services from us since we started asking for the additional fee,” Mr. Flury said
A “significant” number of patients have agreed to pay the fee, Mr. Flury said, declining to comment further.
“We do not want to create any undue financial hardship for any of our valued patients and would be glad to answer any questions you may have regarding this decision,” the letter said regarding payment.
The fee covers services that are not reimbursed by health insurers, such as the phone calls “triaged” by staff nurses, prescription refills and printed information, the letter says.
The extra charge also will help offset the practice’s malpractice rate, which has jumped 128 percent in the past three years, Mr. Flury said.
The fee is not a standard policy among all Maryland physicians, but state medical groups acknowledge that several practices are implementing the surcharge.
“I’ve heard a sporadic number of practices are doing this across the state,” said Dr. Karl Riggle, a Hagerstown, Md., general surgeon and president of Save Our Doctors, a coalition of state doctors that opposes rising medical malpractice rates.
The Greater Annapolis Medical Group set up a voluntary, $25 annual fee per patient from September to November, when the General Assembly was fighting over medical malpractice reform.
Dr. Andrew Gordon, a general internist with the group, said the majority of patients seen during the period agreed to pay the fee. He would not say how much was collected during the period.
The fee was meant to provide administrative relief in the face of surging malpractice rates, Dr. Gordon said.
The Maryland State Medical Society, which represents 7,000 doctors, said physicians have been considering the extra fee for the past few years because reimbursements from health insurers have been relatively flat.
But the group has cautioned doctors that the surcharge could bring pitfalls, such as patient alienation or violation of state laws, said Executive Director Michael Preston.
Maryland Citizens’ Health Initiative, a Baltimore health advocacy group, said it was concerned the office fees could limit patient access to care.
“It puts another squeeze on the middle class, and we’re already struggling to afford health care,” Executive Director Glenn Schneider said.
Despite medical malpractice reform enacted earlier this year, Mr. Flury said the Columbia practice has not received any relief on its malpractice insurance rates.
The General Assembly in January added a 2 percent tax on HMO rates, which was largely passed onto HMO policyholders in the state.
The taxes funded state subsidies that so far have been offered only to physicians covered by the Medical Mutual Liability Insurance Society of Maryland, the state’s largest malpractice insurer.
The Columbia doctors’ office is covered by one of the other three insurers in the state, which have not completed the subsidy process.
Please read our comment policy before commenting.