January 20, 2015



My question comes from a visit my mother made to her doctor recently. The doctor's regular practice was to see the patient, perform a venipuncture, and call with the test results. At this most recent visit, my mother showed me a letter than required her signature stating that in the future, normal blood test results would come from the office staff, and if the results were "abnormal" the physician would come to the phone following a prepayment of $25. My question is this: is this a legal procedure? It sounds almost like coercion on the part of the physician.



Yikes!  As we have discussed in this forum before, there are certain services a practitioner can bank on as falling under "concierge" or "non-covered" service for which an administrative fee may be charged, however, discuss results for a test that has been conducted by the practice and covered, and for which an E/M visit has likely also been charged is certainly not one of them.  

It is my understanding, although I am not a coding or billing expert that a practitioner could have the patient come back in to discuss results and that visit would also be chargeable as a separate visit, which would be kosher.  But, charging (especially requiring pre-payment) for a practitioner to make a call on a test result already billed - no way that is okay!  The results discussion by phone if not covered separately by insurance is most likely covered under the test cost, and therefore additional charges will be duplicative and in breach of contract if the practitioner participates with that patient's insurance.  Also worth mentioning, the easiest way to get yourself reported is to bill patients for unwarranted charges, or excess of their expectation for paying. 


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