In a message dated 8/14/1999 9:11:34 AM Eastern Daylight Time, writes: > I would consider it at least impolite ... if not unethical or > illegal. (Giving the discount in the first place might be unethical or > illegal, since the HMO -- which does not get to take adavantage of the > courtesy discount -- might consider the discounted fee your actual regular > fee and the undiscounted fee your "inflated for HMO only" fee...) I believe he said it was an HMO that he does not have a contract with. He is not billing the HMO, just the patient. I don't think there's any problem with giving the patient a discount if you're not billing the insurance company--it's done all the time. As for rescinding the discount, I'm really not sure. It's a courtesy discount, assuming that the patient could have seen an HMO doc and just paid a small copay, but really wanted to see you instead. It's certainly discourteous of the patient to then not pay you, after you went out of your way to be nice to them. It seems to me that it would not be unethical to send the entire amount to the collection agency, but I'm not sure I would do it. Moshe Adler, MD