Q&A: When patients request 'frivolous' letters

Q: Are doctors required by their contracts with insurers to write letters at patients' request, even when the doctor believes the request is frivolous? For example, a patient called us after he'd taken a week off work and asked us to write his employer a letter saying the time off was medically necessary, even though he'd never even called us or come into the office prior to taking the time off. If we do write these letters, can we at least charge patients for our time spent writing them?

A: Generally, the cost of writing letters is not included as a covered service under managed care contracts. As such, you're free to decline to write letters that you deem medically unnecessary, and you can separately bill patients for time spent writing most letters. There may be certain exceptions, such as when the letter is related to filling out insurance forms. Otherwise, school and camp clearance, work evaluations, etc., are generally not covered. Of course, charging for a two-sentence, handwritten note is not necessarily a good business decision. By contrast, drafting a five-page report is certainly a reimbursable service.