The current scrutiny of health insurance company billing practices has revealed many questionable practices around billing. But a new one has surfaced that is indeed novel: adding a surcharge for processing a payment that actually saves the insurers money in the first place.

A recent article in the publication Pro Publica revealed that health insurers now impose a fee of 1.5% to 5% on doctors who are paid electronically. The fees are ironic because the same insurers virtually forced doctors to accept electronic payment rather than checks, because electronic payments were cheaper to process.

Technically, the insurers don't extract the fee. Their henchmen – middleman companies that process the payments – began adding the additional fee as part of their "service." Never mind that the insurers were already paying these firms to manage payments. Further, Pro Publica said, the middlemen often share the fees with insurers.