Abolishing “blank check” policies in medical offices

23Dec10

As part of the new patient forms that you fill out when visiting a medical or dental office for the first time, there’s usually a seemingly innocuous document stating that you agree to pay the fees for services rendered. I’ve never thought twice about that stipulation before, but a recent experience made me reconsider my viewpoint. In particular, an unethical medical practice could use the signed form like a blank check, and insist that you have to pay everything they invoice you — no matter how outrageous the fees might be on a per-service basis.

These “blank check” agreements should be abolished in medical practices. In fact, replace healthcare with any other industry, and the behavior would be considered unethical, and might even count as fraud. For instance, suppose you bring your car in for repairs. Any halfway decent mechanic will give you an estimate ahead of time, and the better ones will guarantee that the final cost won’t exceed the budgeted amount.

In the healthcare industry, though, it can be nearly impossible to get a pre-treatment estimate, or even a bill after services are rendered. Case in point: I had a routine procedure done recently at a doctor that I know and trust. Before the appointment, I called to get the procedure code and estimated cost, and they told me they couldn’t provide that until the day of the visit. Next, when I completed the appointment and went to the checkout area, I asked for the bill, and they told me it wouldn’t be ready until the following day. Finally, I called back the next day, and they said bills take a week to generate, so no costs were available yet. It has now been about a week since I saw the doctor, and I still have no idea what my visit cost.

I doubt my experience was all that unusual, and this is an excellent example of where the government should step in and abolish the policies that lead to this type of abuse. Namely, any sort of “blank check” agreement that the patient signs should be deemed unenforceable unless the doctor also provides a written estimate before each visit, stating how much the visit and all related services will cost. If they fail to provide this estimate, or the patient never signed off on it, then the law should provide a maximum billing amount of something like $50 or $100 for that visit. In other words, the patient would only be responsible for paying large fees if they agreed to them in writing.

Sure, this is more work for healthcare providers. Some patients might even refuse to sign the estimates, although those are probably the same people who would have refused to pay the bill when it arrived. Despite these minor drawbacks, banning “blank check” agreements and requiring upfront disclosure of medical costs is fair for all the parties involved, and it’s a shame that the US hasn’t put those policies in place already.



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