Fee for "Letter of Medical Necessity"?

I've mentioned that I've been thinking about getting a new doc for a while. I liked my old doc but the place isn't very cozy, I've been there 4 years and haven't really engaged w/the staff, who are polite but pretty slow. When things happened (once...), by the time they got the docs rx to change my pump settings I'd already done so. Then the new (old, she was there before...) doc *failed* her appt spectacularly as I got there and she goes "well, your A1C is 6.2%, not too bad, pretty good..." except, of course that 1) it was up like 20% from where it was before but that didn't seem to alarm her and 2) the paper printout they got was marginally legible and, in fact, they couldn't tell if the first digit was a 5 or a 6 so they just ■■■umed it was a 6!! I'd checked online and knew it was 5.2 but the whole experience left me feeling a bit flat about it.

I've been aware of a different, larger well, I guess, flashier clinic in a less convenient location. My friends take their daughter there and they are the Endo affiliate of the large, local hospital, which I'd scouted, but blew off for the seemingly smaller, local office before our move and decided the hike up to the next town wasn't worth it. Now, w/ this situation w/ the sloppy doc, I figured "what the hell, I'll give them a try" and have an appointment in a week. The other day, I was confirming their location (ok, looking for shortcuts...

) and noticed a "shopping" section and thought "what, do they have T-shirts and hoodies?" so I figured I'd see what they were selling and was moderately alarmed to see a fee for "letters of medical necessity" for $25 which seems a bit steep to have a clerk type "ctrl-V" and fill in a couple of blanks. $10 for a co-pay not paid at the time of service, $25 Re-billing Request necessitated by lack of or incorrect information supplied by the patient. $75 for an insurance request for extensive review by a physician. $50 for "complex forms" including pharmacy/ mail order medication change requests. Am I nuts to think these charges are unusual? I haven't ever encountered this sort of thing before. I can still call and cancel (to avoid what I'm sure would be a charge for a missed appointment...hmmm, they don't have a credit card # though...) and could just give the current doc a pass for now as that clinic has always been very manageable from my perspective.

I think that more and more doctors are applying fees to administrative things. And I understand, I've heard that up to 40% of the costs of running a practice go to administrative stuff, particularly insurance. But many of these are likely to be uncovered expenses for insurance purposes. And it isn't just the nickle and dime fees, I've run into a number of doctors that make you come in for a visit in order to refill a prescription.

So I actually ask about some of these things. My current endo does all this stuff for free and goes out of her way to support her patients. But I do "manipulate" the system to make sure that I am not requesting the services. I don't make direct requests for refills or renewals outside of appointments, I make the pharmacy do that. And I would try the same thing with letters of medical necessity, I don't require that, insurance requires that, so they need to request it from the doctor and pay any fee associated with it. You just have to get someone else to make the request.

This kind of sounds like bullsh*t to me: these things they are charging extra for seem like basic functions of a medical office. I mean, I can understand charging someone who is taking advantage of a situation...but this seems unreasonable.

That being said, it could be that the doctor him/herself is fantastic, and this is some policy they have no control over. After meeting the doctor, you can see if all this crap is worth it (I'm guessing they have other stupid policies). You can even bring this issue up and see what s/he has to say. I love my endo but the office staff is ridiculous and horrible, for example.


My endo is a factory. Fees for everything, but my favorites are missed appointment ($50) and calls for prescriptions outside of an appointment, also $50. Isn't it hard enough having T1--they make it harder.

I would keep the meeting and ask the Endo about the fees as they are the bosses of the office. I do not know if I could go to a doctor like this as it feels like they don't have thier patients' best interest in mind.

That being said it probably is legal and becoming more common practise. I recently learned that lawyers in my state can bill their client for the amount of time it takes to create the bill! Now that is over the top.

Wish i were surprised brother... it is pathetic.

You should let them know their website is pathetic, crass-commercialism and irrepairably offensive, THE reason for your permanent cancellation!

Thanks guys, I have to admit I'm not 100% sure if the old doc charged for this stuff or not, you get bills in the mail, you pay them, etc. I don't recall seeing anything itemizing $25 for that particular document though. My inclination is to go to the new doc and see what it's like. They've been on my radar since I move to Chicago in 2009 but I'm very lazy. Maybe some new blood will help the BG?

My PCP, who I love and is very intelligent has treated me for decades but then sent me off on a endo hunting adventure when I turned to the pump. On my last visit to my PCP, I told her I no longer wanted to see the endo, because I never then went to see her. I said I know what I am doing with the pump and I want her to start writing my RX's again, and she said..........yep she will. Even when I was in the hospital for my three skull fractures, did not turn to my endo, did everything on my own, so I am dropping my endo and if I run into problems will probably turn to an endo in my PCP office.

Didn't you, not to name any names or anything, go to the endo in question Karen? There's kind of slim pickins around here but I know one other one. Argh, this is frustrating. It bugs me that I give these people a crappy used car worth of fees every year and they don't do all that much, other than what I tell them to do.

Nice catch on the additional fees! You were fortunate to notice them BEFORE starting with that practice.
It took me two years to get up the nerve/gumption to switch medical practices. My old care: a huge, bureaucratic, if high quality teaching med center. I seldom got an appointment with a doctor I requested; NEVER saw my supposed PCP. When I was dx w/ diabetes, I was assigned to a second year resident. But I liked her, she seemed thorough. But once she moved on, so did I.
Now I'm at a smaller practice, with good staff, and I always get to see my PCP. By appointment 2, I felt that she & I had developed a good rapport. She seems sensible.
While I'm glad I made the move, it has involved learning a whole new set of protocols re billing, etc.
I guess it depends what you are hoping to gain from switching your practicioner(s).

Never did Mike, and I have yet to find a good endo and I have been to a lot of them over the years. I find specialists annoying, and that is why I am so happy to go back to my PCP, she covers all areas, and when she was treating my diabetes, she understood how it effects every cell in your body, in fact she stated that one time. As far as pump changes and dosages, I don't think she can help, but then endo's advice never worked either.

I've never seen such fees in 2 states, and I have a high needs child who has seen a lot of docs. Most of the fees sound ridiculous.

Not real sure what to think of this. On the one hand I completely agree with what everyone has stated but on the other I kind of want to say kudos to the doc. He is being honest in acknowledging that there is a significant amount of overhead forced on him by government and insurance regulations for which he is not reimbursed. As such, there are two approaches...raise costs, which isn't really an option since reimbursement rates are being cut left and right, or pass them on to us. By doing that, outrage will result which will then be passed onto our elected officials by us. Kind of brilliant if it catches on. In the meantime, I'll pass unless this guy / gal is literally brilliant.


Those fees are standard for most physician practices where I live including family practice and internists not just specialists. They don’t charge for prescription refills, preauth’s, tests, etc, and they may elect to waive the fees but they all charge fees for FMLA paperwork, L&I paperwork, CDL paperwork, school or work related paperwork, etc.

I have never seen an actual itemization for an invoice from the Joslin Clinic where I see an endo and a CDE. But the insurance company has never balked at paying whatever they've charged so I guess it must be legitimate. The "letters of medical necessity" fee would kind of ■■■■ me off though. As someone said, if the insurance company requires such a letter then let them pay for it.

AR, that is very common here especially in the bigger practices who can have HUNDREDS of patients to deal with. While it doesn't sound like a lot of work, these forms, especially if you have multiple ones can be very time consuming to fill out and complete. I had to pay a 25 dollar fee for my surgeon to do my letter of medical necessity for my FMLA recently. It's time involved and time is money. And when you are a large practice that can see HUNDREDS of patients, you can get bombarded with these requests.