MIAMI (CBSMiami) — Hospitals and doctors offices across the country are tacking extra fees onto your bill.

Doug Rischbieter booked his appointment six weeks early with a doctor he’d seen for elbow problems five years earlier.

But when Rischbieter arrived, he learned the hospital had changed his doctor.

His elbow felt much better when he left, but he said the bill he received stung because it included a $164 new patient fee his insurance didn’t cover, he said.

“They said they automatically charge it to anyone who hasn’t been to the facility in three years,” he said.

“That does not seem fair,” said Amy Bach, a consumer advocate at United Policyholders.

Bach said hospitals are getting creative with fees, not unlike the airline industry.

Fees for phone conversations with doctors, calling in prescriptions, or fees to cover malpractice insurance increases are among the most surprising, she said.

The new patient fee applies to patients who haven’t seen a doctor in the same subspecialty in three years.

“Piling a fee like that, surprising somebody, is not the way to run a healthy medical services system,” Bach said.

The American Medical Association adopted the new patient rule years ago after it was implemented by Medicare, and the policy is now followed by many doctors and hospitals nationwide.

UC Davis Medical Center defended the charge.

“Our new patient charge is a fair reflection of the additional time and resources required to get completely up-to-date on a patient who hasn’t been seen in more than three years,” public information officer Charles Casey said. “The charge is common nationwide because it reflects a clinical reality, which is why health insurance typically covers much of this cost as part of a payer’s negotiated contract with providers.”

Rischbieter’s insurance, however, did not cover the charge, he said.

The medical center stood by its charge.

Reluctant, Rischbieter said he will pay it.

“I don’t think the charge is right,” he said. “I don’t want to get caught with collections or overdue bills.”

As to why UC Davis didn’t disclose the additional charges when asked beforehand, according to Rischbieter, UC Davis said can’t anticipate every single charge.

If you’re covered by a private health insurance plan and get hit by any extra charges, check with your plans’ administrators to see if extra fees are allowed.

If you go to any independent clinics or out of network doctors, it’s a good idea to find out about all the extra charges before seeing a doctor.