... they also have to adhere to ONE policy in their office financial policy.It is not clear whether this statement refers to the percentage discount the doctor gives, or whether it refers to the cash price for a particular procedure.Is this a Federal requirement? State requirement? Requirement of individual insurance carriers, based on the doctor's contract with them? If doctor is a non-participating provider, he can charge any amount he wants. What the patient bills their insurance is of no concern to the doctor. That is, I think the answer to the original question is more along the lines of "it depends" - on whether the doctor is a non-participating provider, and what his contract is with the insurance carrier if he is a participating provider.[Edit] I'm thinking that, if a doctor is a non-participating provider, the insurance carrier cannot regulate what he charges or what discounts he gives. And if a doctor is a participating provider, I'm thinking that cash discounts would be regulated very heavily by the insurance carrier.A link or reference to a regulation or insurance carrier requirement on this issue would be useful.
I was just wondering - becausemy clients generally stick to a consistent percentage discount. But they don't hesitatate to vary from that when the patients circumtances call for it. But that is generally only when they are not PPO for the patient's insurance.
Linda, you said ... an office has a financial policy in their office (AS THEY SHOULD) ... I'm not trying to be difficult here. Your readers deserve an answer. WHERE is the regulation that leads you to believe that they should have a financial policy? You obviously believe that a financial policy is a protection against something. What is that something, and where is it defined.
All of this leads to the following fact: the doctor's fee is what he charges his patient. The charge given to the patient sets his fee for that patient. The fact that he might charge someone else 10% more or 20% more has no bearing on what his fee is for this particular patient. The doctor's fee is what he charges the patient. Your lawyer may be erring on the side of caution, but he is making an economically-incorrect (and probably legally incorrect) statement to say the doctor is returning a portion of his fee to the patient - because there is no law that says a doctor or hospital has to charge the same fee (and publish a list of fees) for the same service to every patient. Google and read as I recommended above and you will see that this is not just my opinion.
And if this is what Linda meant by having a financial policy in place, then I agree with her - it makes sense to have the lawyer's finding compiled into a format that can be readily accessed and looked through re. what regulations constrain that particular practice with regard to price discrimination.
The original question was: what is the legality of it all?Personal opinion does not answer this question. References to ethics does not answer this question. Either I don't know, or links to relevant regulations, would answer the question.
Billergirlnyc, you said ... As my attorney always says he tells his physician clients: Exercise extreme caution because things can go bad really quick when you factor in the anti-inducement provision of HIPPA [Federal], the Medicare exclusion provision [Federal], state anti-kickback statutes [state], and state insurance anti-discrimination provisions/laws [state]. That's a better start, because it gives the reader something concrete to research on his own.
However, price discrimination by physicians and hospitals is legal. The Robinson–Patman Act of 1936, an amendment to the Clayton Antitrust Act, prohibits price discrimination - but only for commodities. It does not prohibit price discrimination for services. And hospitals and insurance companies and doctors do engage in price discrimination - all quite legally. For those interested in more information, Google on "price discrimination" + healthcare (or 'doctors').
Great.. we understand you have no problem with the doctor just making random and arbitrary arrangements with patients. Your job is then easier, but let us do what we feel in the best interest of our clients. We, no, I'll speak for myself, would rather air on the side of caution and add COMMON SENSE to the mix, and spend my time much more efficiently that working with providers who are not interested in right and wrong unless I legally prove it to them. If I had a client that was randomly giving away the farm to some and not others, didn't have an office/financial policy, and didn't care enough to put his business first, then, I'm not needed and my time is better spent with clients who do want to do the plain ol "RIGHT" thing. I do feel better your picking on others and not just me <g>
Many providers have similar cash dicounts, but what is the legality of it all?