ANNUAL ADMINISTRATIVE PCP (PRIMARY CARE PHYSICIAN) FEE
FOR NON-MEDICARE PATIENTS
PATIENT NOTIFICATION OF OUR NEW REQUIRED ANNUAL ADMINISTRATIVE PCP
(PRIMARY CARE PHYSICIAN) FEE FOR NON-MEDICARE PATIENTS:
WE HAVE A BIG CHANGE HAPPENING AT OUR PRACTICE. PLEASE BE SURE TO READ THIS WHOLE MESSAGE SO THAT YOU FULLY UNDERSTAND THE CHANGE STARTING SEPTEMBER 2025. WE WILL BE GLAD TO ANSWER ALL YOUR QUESTIONS AND CONCERNS.
All of the doctors and staff at Block, Nation, Chase & Smolen Family Medicine are committed to providing you with exceptional care. But there have been many changes in the health care industry over the years, and these changes over time have unfortunately caused a very significant rise in the administrative costs for operating a medical practice and for managing the care of patients.
Currently, when not actually seeing patients, the doctors spend up to 20 or more hours weekly providing services for our patients for which we are not reimbursed by non-Medicare insurance plans. These hours include refilling medications, answering messages, providing updates about test results, sometimes treating by phone messages without a visit (when appropriate), coordinating care such as referrals, helping to make sure medications & other care gets approved by insurance plans, filling out forms, and more. These necessary services, though time consuming, are not covered or reimbursed by non-Medicare insurance plans.
We also now need two full-time nurses just to assist with getting insurance approvals and processing of medications, referrals, and radiology testing as well as providing other required data to insurance companies. Additionally, we have had to increase our billing staffing by 50% due to the progressively worsening complexities of getting fully reimbursed from insurance plans.
Not only have our staffing costs gone up due to needing more staff to provide the same overall care for patients, but our costs have gone up significantly for maintaining electronic medical records. This computerized functionality is necessary for capabilities such as the patient portal for portal messages, remote access to review medical records, the Healow smartphone app, and the ability for us to transmit controlled drugs to pharmacies, which includes medications for sleep, pain, and attention deficit disorder without making patients come in to pick up paper prescriptions between appointments.
While the services and benefits that we provide to patients have grown immensely over the years, sadly many large insurance plans have done very, very little to factor these rising administrative overhead costs into how they reimburse us for the care that we provide. For example, if we look at three of the largest non-Medicare insurance plans in our region and in our practice:
- Florida Blue has only given us a total of a 2% raise in our reimbursement rates in the past 12 years
- United Healthcare has only given us four raises in the past 14 years (the last one being over 3.5 years ago)
- Aetna Healthcare has only given us two raises in the past 12 years, despite us having very good patient care statistics.
We always strive to provide you with the highest quality medical care and high-quality customer service. Over the past several years we have absorbed the rising administrative overhead costs of our services, since these aspects of your care are not covered for reimbursement by your insurance plan. Unfortunately, with record inflation in recent years and with not receiving significant increases in insurance reimbursement rates, this has become unsustainable.
In recent years an increasing number of primary care physicians have coped with the rising administrative costs by selling their practices to hospitals. We are determined to avoid this route — we want to remain an independent practice so we can always recommend what we personally feel is best for your care, without a non-physician administrator strongly influencing where we are supposed to send you for testing and specialist referrals. We also don’t want administrators who work for a hospital potentially making staffing and policy changes that worsen customer service for our patients. Our ability to be make independent decisions that are best for you is one of the reasons why you have chosen us as your primary care providers.
After much consideration, we find it necessary to start charging an Annual Administrative PCP (Primary Care Physician) Fee each year of $100 per adult patient and $50 per pediatric patient (through 21 years of age).
This Annual Administrative PCP Fee will be used solely to help defray the cost of the types of services we described above. Please note, this is considered a non-covered service by non-Medicare insurance plans, so your insurance company will not cover the cost of this annual administrative fee or any of these services.
If you have Medicare Part B (the physician coverage part of Medicare) or you are on a Medicare Advantage plan, then be sure to update us ASAP if we do not already have this information on record for you. Medicare patients are exempt from this Annual Administrative PCP Fee, since Medicare already recognizes the need to compensate primary care physicians for these administrative services and will pay us for this.
We know that this Annual Administrative PCP Fee may represent a big change in cost expectations for seeing us, but we believe that we have set the price at an affordable rate (about $8 per month averaged out), and we have no plans to raise this fee in the near future.
This Annual Administrative PCP Fee will go into effect starting September 1st, 2025, and will be expected to be paid at your first visit with us on or after this start date. This fee will also take effect September 1st, 2025 for patients in whom we handle multiple aspects of care remotely such as messages, prescription refills, and insurance authorizations.
This Annual Administrative PCP Fee will be billed as a recurrent fee each year approximately 12 months from the 1st month that the fee was initiated for each patient. There is also an official “Annual Administrative PCP Fee Acknowledgement” form that all patients or their guardians need to sign one time as per insurance plan requirements.
We appreciate you entrusting us with your care, and value the opportunity to continue providing care for you in the future. Thank you for your understanding.
Doctors Block, Nation, Chase & Smolen
(all information provided is up to date through 07/01/2025)
BELOW IS A GRAPH FROM THE AMERICAN MEDICAL ASSOCIATION THAT VISUALLY ILLUSTRATES OUR INSURANCE UNDERPAYMENT ISSUE, AND EVEN THOUGH THE RED PAYMENT RATE LINE IS BASED ON MEDICARE RATES, ALL NON-MEDICARE PLANS BASE THEIR REIMBURSEMENT RATES AS A PERCENTAGE OF MEDICARE RATES:
Annual Administrative PCP Fee Acknowledgement Form