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From Connecticut, USA:

Our son is a patient at a major university pediatric endocrine clinic. We recently received a letter from them stating that, because of the increase in volume of "telephone consultations", beginning 4/1/97 they would start charging for phone call advice (including calls for changes in insulin dosage). They encouraged us to assist them in educating payors about the cost effectiveness of telephone consultations, and to appeal any denial of charges for telephone advice and help.

We are wondering if any of you have heard of such a practice. In view of the nature of diabetes, and that a child's insulin needs can change at a moment's notice, how do you all feel about charging for telephone calls? We are considering transferring our son's diabetes care to another group located nearby.


I think that one of the biggest problems for diabetes doctors and for diabetes educators is that our patients (and the insurance companies) expect us to give our services away. It's been a service that we've traditionally provided at no charge to the patient, and that the insurance companies refuse to pay for.

I happen to agree completely with the Clinic, that there should be a charge for these telephone consultations to adjust therapy. However, it's been very difficult to collect the money (unless there's clear notice in advance, like the letter your son received) and the patient understands that there will be a charge that they are responsible for paying.

Don't change doctors because of this charge. The next doctor is either going to:

  • bury the telephone calls in the routine office charges (which is what I do),
  • start charging for telephone calls as soon as he/she hears the University clinic is, or
  • refuse to manage the diabetes by phone, making your son spend time and gasoline and money to get the advice at the office.


Additional comment by Dr. Lebinger:

One of the problems with insurance reimbursement these days is that there are many insurance codes (CPT codes) for "accepted procedures" which are not reimbursed by all insurance companies. For years, there have actually been insurance codes for telephone advice, but few insurance companies reimburse for these services. I think a major advance in health care would be to establish a law that all procedure codes be recognized and reimbursed by all insurance companies.


Original posting 14 Apr 97


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