Hi! I bill for a doctor in southern CA who charges fees outside of what we bill insurance, and what it boils down to is that these fees are for non-billable (or another term is non-reimburseable) services. Administrative fees are not billable to insurance, so from what I've learned, it is perfectly legal for your sister's doc to charge her an annual administrative fee. Again, this is in CA, so I'm not sure about other states. These services can be paid for by an HSA, if your sister has one. I hope this helps, but I would certainly check w/ your state just to be sure!