More doctors charging extra for services that once were free [Sun Sentinel, Fort Lauderdale, Fla.]

Feb. 10--Want to see your doctor without an appointment? You may have to pay a little extra.

Skip an appointment, ask the doctor to fill out a life insurance form, get a printout of your medical records -- all those may cost you $10, $20 or more.

In South Florida's extended weak economy, medical experts say a growing number of doctors are taking a lesson from airlines and banks by charging separate fees for services that used to be free.

Ignatius Paul Bertola, for one, is steamed.

The retired painting contractor was charged $200 last month by his Boca Raton back specialist -- on top of the normal bill -- to come in on a walk-in basis to get four cortisone shots in his back. He paid because he said he couldn't bear the pain for four days to wait for the next open appointment.

"I said, 'Doc, isn't this a little exhorbitant that I have to pay $200 extra and you're my doctor?' I feel like I got ripped off," Bertola said.

Such converations are more common, according to doctors, heath care attorneys and physician consultants -- especially in South Florida, where many unemployed and uninsured are spending less on doctors.

Doctors said their incomes being squeezed. Budget-conscious patients are skipping annual checkups, follow-up visits and screening tests, while overhead costs are rising and insurers are tightening doctor payments.

"Doctors want to take care of their patients and do the right thing, but they have overhead to cover. In some cases you have to pass along the costs to the patients," said Shawn Franklin, chief operating officer of Medical Specialists of the Palm Beaches, a Lake Worth-based firm with 75 doctors in 30 offices.

The practice is charging $25 for missed appointments but has held off adding other fees, he said.

Primary-care doctors may be the most interested in adding extra fees because they have the lowest incomes and are being asked to do more, said Dr. Kutty Chandran, a Coral Springs internist who is president of the Broward County Medical Association.

Family doctors shoulder many duties that are not covered by normal medical bills, such as getting approvals from insurers, coordinating treatments with other doctors, advising relatives how to care for sick patients and filling out paperwork, he said.

"You'd be surprised at the amount of time we have to spend on these problems," Chandran said. "Doctors have to seek new forms of revenue."

He is more often charging patients for copying medical records.

Experts said patients may find themselves charged extra for other services: Getting doctor advice by email. Having blood work and urine samples performed at the doctor's office instead of a testing lab. Paying bills in installments.

Some experts advise doctors against a la carte fees.

"You gotta be careful about nickel-and-diming. It can annoy people," said Ken Hertz, a consultant who advises doctors for the nationwide Medical Group Management Association, a physician research group.

Doctors also must be careful because some fees they want to charge violate insurance rules, said Jean Acevedo, a Delray Beach physician consultant.

Medicare and insurers ban doctors from charging patients extra for services that are covered. Doctors who break the rules can be fined or dropped by an insurer, said Jim Farrell, a health-care attorney in West Palm Beach.

Paul Bertola's doctors at the Florida Back Institute said they worked with a lawyer to set up their no-appointment fee. They legally collect $200 to $300 by seeing walk-in patients when the doctors are normally off-duty.

It's the same idea as concierge doctors, where patients pay an annual fee of $1,500 to $2,000 for more service, such as extensive access to the doctor and free screenings.

"We are working extra for them. It's an extra service," said Bertola's doctor, Jeffrey Fernyhough. "We're not going to put somebody in front of other patients who have appointments, just because they say their back pain is worse. You can't do that. This is the fairest way."

The scenario raises questions. It makes doctors or assistants decide which walk-in patients need urgent care without the extra charge and which ones are there for convenience and can be charged, said Wayne Lipton, a physician business expert at Concierge Choice Physicians in Rockville Centre, N.Y.

Take Bertola. Fernyhough described his condition as "moderate distress." Bertola called his back pain "agonizing" and urgent, a result of 50 years of degenerative discs.

"I was in so much pain, I didn't care if I had to pay the $200," Bertola said. "But I told them, 'This is like being held up.' "

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