The Checkout

A Bitter Fee to Swallow

Let me be blunt. I hate all these extra fees added in bills these days: those daily resort fees at hotels for services that should be provided in the first place; those added extras to the phone bill which, in total, can be as much as the basic phone service costs and those car rental add-ons too aggravating to even write about! You've seen them, too. You've paid them. And I'm sure you hate them as much as I do.

And just when you think you've seen them all, there's always another fee to be found. I spotted a doozy last week in a doctor's examining room: "Please request prescription refills during office visits. Prescription refills filled by phone or fax will have a $20 service charge--paid by credit card at time of request."

I know doctors have lots of added paperwork these days--but at $20 a refill, that's often more than the medicine itself (particularly if you have a prescription card)! In other words, it's a bitter pill to swallow.

Have you seen other maddening fees? Post them here or let me know at thecheckout@washpost.com

By  |  January 30, 2006; 11:00 AM ET Customer Service
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Comments

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How about the prep and delivery fee of $350-$500 when you buy a car. The fee is to cover the fees associated with the final delivery of the vehicle. I used to work at a car dealership and essentially they are charging this fee to wash, vaccuum and armor all the car. This work is done by people making $7- $8/hour. And an entire car takes all of 30 minutes to prepare with only one person doing the work.

Posted by: John | January 30, 2006 12:47 PM

You are complaining about a $20 prescription refill service fee? What do you think, they just receive the call or fax and hit some big button and instantaneously notify the pharmacy without any further actions? Do you realize that 1) someone has to receive your call/fax, read it and document it, 2) your chart has to be pulled and the doctor has to review why you have the prescription in the first place and whether it should be renewed, 3)DR has to forward relevant info to office staff, 4)office staff have to notify your pharmacy.
Compare this to you, while sitting before the DR at an office visit, say “Hey Dco, my script runs out in three months, can I get a refill while I am here?” He looks at your chart for a sec, asks you a few questions, and issues you the refill.
You basically want them to do all the work, including dropping the prescription off for you, so all you have to do is swing by and pick it up. $20 seems like a deal, if you ask me. And no, I am not a DR

Posted by: Skipper Todd | January 30, 2006 1:30 PM

I am absolutely outraged by the service fee and/or late charge by credit card companies to "pay your bill the same day."
This amounts to not only the $15 or $35 dollar obvious charge, but will certainly result in an interst rate hike as well.
HOW IS THIS LEGAL??? Let alone fair to consumers??

If I authorize a payment over the phone or online, could someone PLEASE tell me how this is different from mailing a hard copy check that arrives on the due date??

Posted by: MMiller | January 30, 2006 2:01 PM

Posted by: Anonymous | January 30, 2006 2:18 PM

For two years, our pediatrician has charged the insurance company for an office visit ($55) to write a refill prescription, every month, for the same medication for the same person. The insurance company balked initially, but appraently now pays it without question.

Posted by: GE | January 30, 2006 2:27 PM

The scenario posted by Skipper Todd may be a situation that occurs, but just as often, if you are taking a regular medication that has no automatic refills, your appointment does not "sync" up with the date that your 'scrip runs out. You must call the doctor and the pharmacy to refill the darn thing. No other option exists. Sometimes, Todd, taking "personal responsibility" doesen't quite get the job done.

Posted by: John D in Houston | January 30, 2006 2:27 PM

The reason why we have all these annoying fees is because we customers aren't willing to pay the cost of actually doing business these days. We're saying, nope, our incomes aren't going up, we're not paying you more, especially when we're paying 50 percent more at the pump for gas.

So, companies are getting creative. They're advertising the low, low price, and disclosing in the fine print -- which covers their butt legally -- that there are fees involved.

Someday, folks, check out you plane ticket. That $300 roundtrip you bought? Betcha the airline got about $250 or so, because you've got a September 11 fee (great, I'm paying so that I can have some moron look at my shoes in the x-ray machine), passenger terminal fees, taxes, etc.

Posted by: Anonymous | January 30, 2006 2:50 PM

Regarding John D's comment: while it is true that oftentimes the patient is not at fault for a phone-in prescription, the same amount of work for the staff is required, regardless of the reason.

Posted by: Jenn in Nashville | January 30, 2006 2:52 PM

Some of the most maddening fees I see on bills are the ones which, according to the law, should not exist! Even though Congress has imposed a moratorium on all taxes on Internet access, many Internet users who subscribe to DSL or cable modem service see "taxes" on their bills. In fact, the money simply goes to the provider, which quoted you a lowball price that did not include this extra fee to get you to sign up. It's not cricket, but regulators haven't stopped it. (Maybe they're baffled by the bills themselves.)

Posted by: Brett Glass, Laramie, WY | January 30, 2006 3:05 PM

Well, I suppose doctors are being nickled and dimed by the insurance companies, and they do have expenses of their own to meet, so the nit-picky charges are rolling downhill. That being said, I'd have a word with my doctor if he started doing this and likely look around for a new one.

Posted by: MJ | January 30, 2006 3:09 PM

I was surprised recently at a dentist visit to pay a $12 "sterilization surcharge" on top of my co-payment. It's not much, but makes me wonder if I hadn't paid, would the tools used in my mouth have been unsanitary? Is this a normal fee?

Posted by: CM | January 30, 2006 3:36 PM

Why do you expect to get free services from the doctor? Insurance companies and Medicare don't pay doctors for the effort expended to refill prescriptions. Other professionals such as accountants and lawyers charge by the minute for time spent on the phone, faxing and copying.

Primary care doctors are struggling to make a living. Many are forced to accept lousy reimburment rates from insurance/medicare and have little power to negotiate better rates. They've spent 7+ years in medical school and training, often have medical school >$100K, yet make less than the starting salary for many bachelor's level graduates.

Posted by: MH | January 30, 2006 3:42 PM

My doctor's office imposes a malpractice insurance surcharge. It is about $9 or $10 and is assessed at every appointment on top of the copay. So I pay the extra. I don't know what would happen if I refused to pay it.

Posted by: BN | January 30, 2006 3:45 PM

MMiller--I have had to use the phone to pay a credit card 'same day' only once, but it didn't result in any interest hike.

I pay American Express over the phone, they don't charge a fee for that. All the others do, though, that I know of, so I don't use that feature except to make sure, as in the one case, I don't get a late fee, which is worse for your credit rating than a phone payment fee (shouldn't change anything, I believe.) And I do it because 2 accounts I have with them are the only ones I can't get on an auto-pay program--which will always work...unless...LAST WEEK one of my mailed payments to Amex was read by their mechanical processor. It was a check for $37, but the reader picked it up as '$837.'Stupidly, I have never gotten overdraft protection since I always thought if I was careful nothing else would happen; and I also never kept much more than a minimum in my checking account therefore. As a result, the extra $800 caused FOUR checks to bounce; and it took 3 days of aggressive work, including getting my bank to fax print detail of my account, to get American Express to agree that they had to refund the $800 as well as the $128 in checking account fees. At first, a soothing-tone-trained 'customer care specialist' (loathsome term) said 'Noooo......we won't, but is there anything else I can help you with?'. Miraculously, my bank paid the overdrawn checks so that they weren't returned, but I've decided to start paying online now or on the phone when possible, because this was sobering and time-consuming.

Posted by: Patrick J. | January 30, 2006 3:46 PM

(meant to include that 2 of those overdrafts were autopayments, so that in a nightmare case like this, that's the one time when autopay can also not work.)

Posted by: Patrick J. | January 30, 2006 3:48 PM

i don't think its too much to ask to be able to phone in a refill without being assessed a $20 fee, or at least a fee considerably smaller then $20. $20 is a little steep. Explain to me how it costs $20 for someone to grab a file, get an ok from a doctor, and fax the script to the pharmacy? For a refill, most of this stuff is already in the computer, so all one is really doing is pulling up some info in a computer and getting the OK, then faxing the order.

For my particular health insurance, my copay is $15, so I'd just as soon go in for a visit. At least I can get my prescription refilled, and have my weight, blood pressure, and temperature checked :-p I can even have the doc check my reflexes and get a tasty lollipop when I leave. All for $15 instead of $20.

For those in favor of the fee, i can see your argument, as *someone* has to do the work of refilling the script. In opposition though, there are many ways to circumvent this fee, which begs the question of why impose it in the first place? One way, switch to a new doctor that doesn't charge. Another way, utilize a prescription service if such a service is offered by the insurance company. UHC allows you to set up automatic refills for recurring prescriptions. All the doctor does is write the script and UHC takes care of the rest, including renewing the script. I don't think the doctor's office is charging UHC $20 to do the same thing I could do by phone, else UHC wouldn't offer it to me for free. What's the difference?

Capitalism, mmmm yummy

Posted by: LA | January 30, 2006 4:58 PM

My favorite fee is the $10 charge imposed by airlines to process ticket purchases over the phone. The fee is especially maddening when trying to use a voucher which the airline refuses to redeem online (American Airlines comes to mind). I sympathize with the desire to encourage customers to move online, but the fee is insulting when the airline is too incompetent to provide a tech-savvy alternative to the telephone.

Posted by: jetsetter | January 30, 2006 5:10 PM

Here's my problem with the refills... it can take up to six weeks to get an appointment with a specialist... so, I see that I have one refill left, call the neurologist, and make an appointment and ask for a refill if the appointment isn't within the next four weeks. I can only understand the refill issue if you get to your last pill and it has to be rushed... otherwise, sorry, it is a part of customer service. If you want for me to continue to be your customer, you have to give me service.

Posted by: Enough already | January 30, 2006 5:40 PM

Sometimes I think the phone company should just include an "overhead" line and a "profit" line on my bill, since that's basically what all those extra charges are.

I think the fees we pay for office visits should include any and all paperwork involved in my care. That should include refilling a prescription over the phone.

Our former pediatrician used to charge $20 to write a refill for a "controlled substance" that couldn't by law having any auto refills. My insurance company wouldn't pay this. So I started making appointments instead, paying my $5 co-payment and having the insurance company pay the rest.

Let's say everyone does this and the insurance companies start complaining so they lower what they'll pay to the doctor for our visits. Who is to blame? Me, for not wanting to pay $20 out of pocket when it's the law and not my choice or laziness? Or the doctor, for imposing this ridiculous fee in the first place?

Posted by: A Patient | January 30, 2006 6:58 PM

My kid broke his phone. When I went to the cell phone place, I was a little surprised to learn that they did not carry a basic cell phone, only the newer web phones with all the fancy crap, and none priced lower than $180. After plunking down 200 clams for the phone, I got hit with a $35 "activation fee." The activation process consisted of the clerk keying in a few numbers on the computer, and took about 20 seconds.

Posted by: Fred | January 30, 2006 7:53 PM

I hear plenty of similar complaints from my parents in NJ: refill surcharges, hidden fees, etc.
In the UK, my wife has to get her regular prescription refilled every 8 weeks or so. To get that done, she fills one slip of paper (half the legal-size page) and posts (or walks it) it to our NHS (National Health Service) local medical office along with SASE. A week later, the new prescription is in our mailbox. The medication at the pharmacy costs her £6.50, the standard NHS prescription charge. So, including postage, she gets it done for under £7 or $12.50. Not to mention free visits to our local NHS doctors.
How much does this cost me as a taxpayer? A 40% top marginal tax rate may seem high BUT I pay no state or city taxes that I would in NYC or in many places on the East Coast. And if you are not in the top tax bracket, NHS would seem far more of a bargain. And what's the quality of care here, you may ask. Frankly, it can vary but it's definitely on par with what my parents get and I used to back in the US, if not better.
So what's my point? Not very original -- the US health care system and its funding got screwed up (er..., reformed) in the last 10-15 years and needs SERIOUS overhaul. Yeah we all know that but I can tell you that other countries now definitely have it better for less $. Something needs to be done ASAP. Unfortunately, I can't write a prescription for how to fix it.

Posted by: Ex-pat in London | January 31, 2006 4:26 AM

I used to work as an office manager for a family doctor. For those griping about these fees, I think this is a good opportunity to learn how our dysfunctional system works.

What's the difference in paying $20 for a phone refill versus a $5 office copay? To the patient, the phone refill costs an extra $15 (plus you'll spend time & gas to make an office visit). To the doctor, they'll receive a total of $50-$75 for an average office visit (copay + insurance reimbursement). Unless the doctor institutes a phone refill fee, they receive nothing. Don't forget the doctor also assumes medical malpractice liability for everything they do. Should they take that risk for free?

If you think an office visit charge should cover all paperwork for your care, then you or the insurance companies will need to pay more than $50-$75.

That office didn't have a refill surcharge yet, but they were considering such measures. Of course you could avoid the charge by requesting refills at your office visit. They also didn't refill prescriptions requested by the insurance companies. Intereseting that someone mentioned United Healthcare, as they are one of the worst payers. Do you know they increase premiums to employers/patients and reduce payments to doctors? They earn record profits and compensate their CEO $125 million last year.

My advice to doctors is to charge the fee. If the patients/customers aren't willing to value your time, let them find some other doctor that'll give away their years of training for free.

Posted by: JDB | January 31, 2006 10:35 AM

If you get hit with the refill fee, just start charging your doctor the $50 (or whatever) per 1/2 hr "time kept waiting" fee while in the waiting room. Then start charging a filing/processing/documentation fee.

Posted by: HP | February 1, 2006 4:49 PM

I made my doctor appointment in September and was given the next appointment, in January. Seems to me that means that she has a pretty big practice. I got to the appointment on time, waited almost a half hour, saw the doctor for less than 15 minutes. I paid my $30 copay and my insurance paid another $180. Now, the doctor's office wants me to pay a yearly $25 to cover nurses, etc. My question, what did the $210 cover? I don't know too many professionals who make over $800 an hour ($210 for 15 minutes = $840 per hour). If I need a prescription refill during the year, I think the nurse's salary could probably come out of that.
Just my opinion.

Posted by: DPM | February 7, 2006 3:09 PM

The charge for "malpractice insurance" is your doctor's way of letting you know that in his/her opinion, medical malpractice lawsuits should be barred or caps placed on non-economic damages, or something similar. The doc's malpractice insurance is part of the normal overhead of any practice (just like your auto mechanic pays liability insurance). This is just a lobbying ploy - the doctor is lobbying you in the hopes that you will come to share his/her opinion about medical malpractice lawsuits. Several of my doctors have petitions they want you to sign, asking for laws to "control" medmal lawsuits; others have brochures or posters about that issue.

Posted by: Virginia Klipstein | February 16, 2006 7:06 PM

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