Patient Financial Policy - Update

Here's a copy of our new patient financial policy:

Without exception, we will not accept responsibility for any charges for materials or services unless the amount (or, at least, an upper limit for the amount) has been discussed with us, and agreed upon by us, prior to the materials or services being rendered.

By signing below, you indicate that you have read and understand our financial policy.

I described the story behind this, and the rationale, in this earlier blog post. Here's the first update on how it's going. So far, not promising.

The doctor/office that I complained about in that post was Dr. Elliot GoldStein, of Physician Associates, in Rockville, MD. After writing that post, I sent them a letter explaining my policy, and a check for the maximum amount that I thought I should be responsible for, $120. I also sent them a copy of the policy form, and asked that they sign and return it. Instead, I got a very terse letter in response -- he fired me! I've never been fired as a patient before, and it was very disappointing!

I wrote another response to them, just now, and all of these letters are copied in full below. Comments are very much solicited -- I'd really like to hear if anyone else has had similar experiences -- getting outrageous unexpected charges from doctors, and how you've dealt with them.

Here's the letter that I sent to him, in response to their bill:

September 16, 2012

Dear Dr. Goldstein:

I enjoyed meeting you and chatting with you, when I came in for a new patient visit this past August 16th. Unfortunately I think there has been a misunderstanding regarding the bill.

When I came to your office, before I went to the back to see you, I informed your staff of my financial policy, which is that I don't accept fees for any doctor's services unless I've been informed of the amount, and approved it, beforehand. I asked one of your staff the amount that I could expect for this visit, and they were reluctant to commit, but finally one woman did indicate that a routine office visit was $120. I again informed them of my policy, and that I wouldn't accept any charge higher than that, unless I was informed of it, and approved it, first. Unfortunately, I didn't get a record of this agreement in writing, because I trusted your office, and while I have been thinking of instituting this policy for a long time, I have not attempted to formalize it, until now.

So, I was shocked to receive the enclosed bill from your office for $342.23 (adjusted down from $400.26). After all, I met with you for less than ten minutes, and I remember, as I was leaving, that you said that I was an exceptionally easy patient, and that you wished all your patients were as easy as me. Furthermore, my wife also recently went to see you for the same thing, viz., a routine new-patient visit without any specific complaints, and she was only charged $198.73.

Because of this misunderstanding, I realize now that I must make this policy formal, and so I'm enclosing a form that I would like you or someone in your staff to sign and then return to me.

I'm also enclosing $120, which is the amount that I believe I should be responsible for, for this visit. I realize that I made a mistake in not formalizing my policy prior to my visit with you, so I'm willing to be a little bit flexible regarding this amount, but under no circumstances will I accept $342.23. I'm CC'ing this letter to my insurance company, so that they can adjust the amount they apply to my deductible.

If you would like to read more about this patient financial policy, and the motivation behind it, I invite you to read my blog post at this web address: http://sinophibe.blogspot.com/2012/09/patient-financial-policy.html.

I hope this experience doesn't sour our relationship -- I did enjoy meeting you and am hopeful that my wife and I can be your patients for a long time into the future. However, I insist that I be informed of what my financial liability will be, in each case, before I can be assumed to be responsible for it. To me, it seems to be an eminently reasonable and fair requirement.

Yours truly,

Chris Maloney

In response, I received the following very terse letter, terminating our doctor-patient relationship!

October 4, 2012

Mr. Christopher F Maloney,

This practice finds that it is unable to provide care that is satisfactory to you. We recognize that some physician's offices and patients cannot come to a satisfactory doctor-patient relationship without fault being ascribed to either party.

Please refer to the directory of physicians provided by your insurance to select another physician and practice in your health plan.

Sincerely,

Physician Associates

And finally, the letter that I just wrote back to them:

Dear Dr. Goldstein:

The letter we received from you today was very disappointing. After all, I went to your office in good faith, and trusted your staff and yourself to treat me with respect and integrity. In response to the misunderstanding about the fee that you charged, I took the time to write a detailed, courteous letter to you. Your response was very terse (basically just a form letter) terminating our doctor/patient relationship. I think that I deserve more consideration than that.

I would like to ask you which of the points of my letter, in particular, you object to. Was it that I took issue with the amount of the bill that you sent, $342.23? Or was it my request that you sign our "Patient Financial Policy"?

If the former, then I wonder whether you doubt my story, that I explained my policy to your staff, and was quoted a price of $120? I'd also like to understand how it is possible to justify a charge of $400.26 (the original amount billed to the insurance company) for a visit that took less than ten minutes.

If the latter, then I would really like to know your opinion about a patient's right to know the amount of financial responsibility he or she incurs, before a service is rendered. Don't you think this is a reasonable request? Perhaps you remember that when I saw you, I mentioned that both of my parents are retired physicians. As a "sanity check", I asked them what they thought of this policy, and they were both in favor of it, and thought it was reasonable and appropriate. It seems to me that the health-care system has moved so far away from the idea of "fee for service", that now the patient is completely cut out of the loop. Don't you see that as a problem?

Because I feel strongly that this is a systemic problem in our health-care system, I have posted my letters and your response on my blog, here: .... I would be very happy if you would respond to me with answers to some of these questions, either in another letter, or, if you prefer, in a comment on my blog.

Thank you for your time,

Chris Maloney