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Common Fees
Below are common tasks LFM performs everyday.
If these tasks are performed outside of a regular office visit or your medical
insurance does not regularly cover these tasks, there may be a
small fee to partially cover the administrative cost.
LFM follows the State of Colorado Guidelines for Balance Billing for Health
Care Services not paid by Insurance --
6-20-202. Notice to patient of debt.
- School forms
Day Care
Kindergarten Care
Elementary School through High School
College & Post Grad School
- Camp forms
- Sports Participation forms
- Medicine refills or Prescription changes handled outside of an office visit
- Phone consults initiated by patients
--Additional Time spent reviewing labs with patient on phone
or e-mail
- E-mail consults and medical care
- DOT (Dept. of Transportation) Physicals -- Lost card replacement only; DOT
Physical requires a visit
- Referrals to Specialists, Physical Therapy, etc without an Office Visit
- Pre-authorizations for Medicines, Referrals, etc
- Disability Forms Completion
- Life insurance forms
- Patient Assistance Programs paperwork
- Narrative Summaries for Lawyers and Insurance Companies
- Insurance Company Summary Forms
- Health and Life Insurance Forms & Information Requests
- Family and Medical Leave Act (FMLA) Forms Completion
- Administrative Charges to cover increasing administrative costs from
--HIPAA, CLIA, DEA (maintaining and tracking of samples
/ supplies)
- No-shows for Routine Visits and Physical Exams not cancelled
within 24-hours prior to appointment
- Surcharge for Co-payments not paid at the time of Office Visit
- Copies of Patient Charts, Medical Records, & Labs
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LFM follows
State of Colorado's DPHE guidelines for reasonable fees of health
facilities
Depart of Public
Health and Environment --
Health Facilities
Division (HFD)
Standards for Hospitals and Health Facilities
- Summary of
6 C.C.R. 1011-1, Chapter 2, Part 5.2.3.4...
- “Reasonable cost” not to exceed
$14.00 for the first 10 or fewer pages.
- $.50 per page for pages 11-40
- $.33 per page for every
additional page
- The per-page fee for records
copied from microfilm shall be $1.50 per page
- Actual postage or shipping costs
and applicable sales tax, if any, also may be charged.
6 C.C.R. 1011-1, Chapter 2, Part 5.2.3.4 -- The
discharged patient or representative shall pay for the reasonable cost
of obtaining a copy of his/her patient record, not to exceed $14.00 for
the first ten or fewer pages, $.50 per page for pages 11-40, and $.33
per page for every additional page. Actual postage or shipping costs and
applicable sales tax, if any, also may be charged. The per page fee for
records copied from microfilm shall be $1.50 per page. No fees shall be
charged by a health care provider of patient records for requests for
medical records received from another health care provider or to an
individual regulated pursuant to Section 25-1-802(1) solely for the
purpose of providing continuing medical care to a patient.
For one or more specific classes of records or services, institutions
may charge additional sums upon presenting a justification therefore
acceptable to the Department.
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