Some physicians say charging patients extra fees is necessary to survive

A growing number of doctors across the country are asking patients to pay extra fees for services insurance doesn't cover, such as no-show fees of $30 to $50 for missed appointments, varying charges for filling out health forms for school, work or athletic teams, and annual administrative fees of $35 to $120 or more to simply be a patient in some practices, reports USA Today.

"It's not unlike the airlines," William Jessee, president of the Medical Group Management Association, told the newspaper, noting that MGMA generally advises against extra fees that may anger patients or run afoul of insurance contracts. "They've gone from all-inclusive to a la carte. That's what you're seeing with physicians."

Although the number of doctors who charge the fees are said to be in the minority, their doing so does not register much surprise with Tony Brayer, MD, a 20-year physician who wrote a response piece on

"With overhead running at 65 percent or above, more and more doctors are leaving practice or burning out," he writes. "The ones who can are joining large hospital-sponsored groups where they are subsidized. These groups know that primary care is a 'loss leader' for the more lucrative procedures that insurance and Medicare reimburses."

Agreeing "that the demands of filling out forms for everything from work questions and school physicals to...countless other tasks that are 'FREE' make it near impossible to remain in private practice," Brayer is in favor of a flat administrative fee of about $125 a year rather than "nickel and diming patients."

And that's what many of the practices profiled in the USA Today article have done, if not somewhat by trial and error. "A lot of doctors are trying all kinds of experimental things just to survive," said Gary Seto, a doctor in South Pasadena, Calif., who charges an annual $120-per-family "non-covered benefits fee."

However, it's prudent to check with insurers before implementing extra charges. "We have seen some increase in that type of activity," said John Syer, a vice president over provider contracting at WellPoint (NYSE: WLP), which operates 14 Blue Cross and Blue Shield plans. "The vast majority do not engage in that," Syer said, noting such fees may violate provider agreements if doctors charge for items insurers consider included in their payments.

To learn more:
- check out the article in USA Today
- read the post on Opposing Views