Non-covered benefits fees

[Guest guest]

I have a question for the group. Have any of you instituted a modest non-covered

benefits fee that resulted in financial (or other) disaster for your practice?

Say, in the $200-300 per year range? I would still be billing insurance, as

well. Here's my background...I have an ultra-low overhead, solo, family medicine

practice that has been open nearly 3 years. I work from my home in rural,

upstate NY, full-time, with my non-medical husband as my only (and unpaid)

staff. We do our own billing and are very good at getting everything the

insurance companies owe us. We participate with only decent payers, including

Medicare (no UHC or Medicaid). Very few of our patients are well-off, and many

are struggling, since unemployment is fairly high here. I give a discount for

PIFATOS for cash-paying patients, which brings their payments down to a few

dollars above Medicare's rates. I accept less from a few people who are in dire

need. Some of our insured patients can't/won't pay their portion after the

insurance companies pay, so we have some bad debt. We have about 540 patients

and could have a lot more, but I keep putting on the brakes to new patients

because I can't do all the work required to take care of them, especially when

they are new. I am chatty and have a perfectionistic streak, so my visits are

long and it takes me wayyyy too long to do my notes. I give super service,

almost always seeing patients the day they call, and frequently in the evening

or on the weekend when it seems they really need it and I am not otherwise

occupied. I accept e-mail from patients, although most of mine don't use it, and

they have my cell-phone number for urgent calls. I do home visits for a few who

are truly home-bound. I enjoy taking care of complex patients, so I am not

always sending them off to a specialist (30-45 minutes away) for every little

thing. I frequently pick up and successfully manage things that the few other

primary care providers in my area miss. My husband says that I give " concierge

care at bargain-basement prices! " As a result, I am basically always working,

but still not making enough money to cover my needs, since I went to med school

late, still have med school loans, and am just finishing putting 2 children

through college. I am 55 and, at the rate I am going, I honestly don't think I

would be in any position to retire until I was at least 75, and 80 would be a

lot safer! (For me, not the patients!!) I REALLY don't want to try to see more

patients, because I feel overwhelmed already, so I am thinking about a fee to

get paid some extra for this fabulous service I give. I don't think there is

enough money around here to support the $1500+ annual fees of most concierge

practices. Even with a much smaller fee, I realize that I will lose a lot of

patients who can't or won't pay it, and I am doing the math to see at what point

I will fall below what I am making now. With a $250 annual fee, I predict that I

could make about the same as I am making now, with about 1/2 as many patients,

and my life would be significantly better. If I kept even more patients, I

could make more, which I really need. I am thinking of giving my current

patients 3 months to decide whether they want to pay the fee and remain in the

practice. So, do you think I will " crash and burn? " ---Sharlene