Advisories alarm Washington retainer practices

The state insurance commissioner is looking intensively at the legality of additional fees charged in these business models.

By Katherine Vogt, AMNews staff. Sept. 1, 2003.

Physicians who charge extra fees for perks like telephone consultations and same-day appointment scheduling may be violating the law in Washington, according to an informal advisory issued by the state Office of the Insurance Commissioner.

The office said it has no plans to try to shut down any of the practices. However, it has embarked on an intensive review of such business models, which have been operating in the state for nearly seven years. The informal probe, thought to be the first of its kind in the nation, has rung alarm bells in the medical community.

"The physicians are madder than hell. They want to be able to meet the demands of their patients. And the patients are very, very upset," said Tom Curry, chief executive officer of the Washington State Medical Society.

Curry said members of the insurance commissioner's office "are attempting to sacrifice the rights of patients to purchase something more than the lowest common denominator of care and the right for physicians to meet those patient demands. And they appear to be sacrificing those rights on the altar of a technical interpretation."

He said the medical society would try to convince the insurance commissioner to re-evaluate the guidance, and if that failed, the organization would consider seeking clarification through the Legislature or the courts.

At issue are medical practices charging fees for extra services such as 24-hour access to physicians and free parking. The practices' business models vary and have different names, including retainer, concierge or boutique practices. Seattle-area doctors are often considered to be the ones who developed the concept.