Please, sir, May I have some more?

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If you feel like you are spending more at the doctors office with each visit, it probably isn't your imagination.

Your wallet really is getting lighter.

A growing number of physician practices are using software programs, some developed by health insurance companies, that can immediately access a patient's insurance information and let the patient and the medical practice know precise co-pay rates, whether a deductible has been paid up and the exact or estimated dollar amount the insurer will pay once the doctor's office submits the bill. Armed with this information, often referred to as "real time claims adjudication," office managers can, and sometimes do, ask patients to pay those costs at the time of service.

Par providers are prohibited by contract from billing and collecting more than the copay for services that are INCLUDED in the copay, but there are no restrictions on collecting for incidentals such as lab fees or non-covered office fee's.

Kati Spencer, 39, a public relations executive in Tempe, Ariz., recently visited a medical center in Scottsdale for a cortisone shot to relieve pain in her hip. The hospital determined that Spencer's $2,600 deductible had not yet been met and asked for full payment of the $2,000 fee for the injection.

Ouch.

This takes wallet biopsy to a new level.

About 13% of physician revenue comes from patients themselves, not insurers, says Mark Rukavina, executive director of the Access Project, a health insurance resource group in Boston. Adds Halley, that's likely to rise as more consumers opt for lower-premium, but higher-deductible insurance plans -- requiring consumers to pay out hundreds to thousands of dollars before insurance kicks in.

Yes, but . . .

The amount consumers pay a par provider, even with a high deductible plan, is less than they would pay absent insurance.

Under the more common practice of contacting insurers first and then billing patients, physicians typically don't send out bills for the patients' share until about 40 days after the visit, Young says -- adding that 30% of those bills go unpaid.

Further, says Dr. Dev GnanaDev, president of the California Medical Assn. and chief of surgery at Arrowhead Regional Medical Center in Colton: "The labor cost for sending out a single bill is $8 to $15, which makes it understandable that a doctor might opt for a more efficient system."

For those of you stiffing your doc for unpaid balances . . . STOP IT.

Some docs are withholding future services until outstanding balances are paid, as well they should. As a result, some consumers go looking for a new doc to stiff.

Bummer.