Facility Fees: “When the Doctor’s Visit Costs Double” by Chuck Bell

The Risk of Additional Hospital Fees, and What You Can Do to Avoid Them

By Chuck Bell, advisor to We The Patients

Over the last several years, health care companies have been buying up many other health care companies.   Physician practices have merged with other physician practices to form larger groups.  Hospitals have purchased many physician practices, clinics and diagnostic facilities such as MRIs.

The result is that offices, clinics and MRI facilities are now legally part of a large hospital system.   When this happens, the hospital system may start charging “facility fees” of $200, $300 or more for each patient visit — supposedly to pay for costs of running the hospital system.

Patients are seldom told in advance that the facility fee will be charged.  They find out about it when they get a surprise medical bill.

In some cases the facility fee is covered by insurance.  But in other cases, it isn’t.  So the patient has to pay it.

How big is the problem?   No one really knows.  But in Connecticut, the state required the hospitals to report how much in fees was being charged to patients.   As a result, we know that hospitals charged about $500 million in facility fees in 2016.  How much was paid by insurance, and how much was paid out of pocket by patients?   No one really knows.

New York state has over 5 times as many people as Connecticut, so that probably means our state’s facility fees might be $2.5 billion a year, or more.

Facility fees are sometimes described as “when the doctor’s visit costs double.”  Renee Harris of Hudson Falls, NY received facility fee bills for her care, and her mom’s care in 2017, according to the Glens Falls Post-Star.   Even though some of the facility fee was paid by insurance, she still had to come up with extra co-pays of $30 each time she went to the doctor, and her mom had to pay an extra $45.   And no one told them about the extra fees in advance!

What can patients do about facility fees?   Honestly, no matter what you do,  it isn’t that easy to prevent them.   You can ask your doctor or medical provider if they are owned by a hospital system, and whether they charge a facility fee for each patient visit.

You also might be able to avoid facility fees by going to a different “freestanding” providers, clinics or MRIs that aren’t part of the hospital system.  So if you have time, shop around!   But patients can’t always do this — and they shouldn’t have to.

If you see a facility fee charge on your medical bill, you can ask that it be taken off your bill by the provider, since they didn’t tell you in advance.  You could also see if your insurance company will pay some or all of it.   You can also call Community Health Advocates at 1-888-614-5400 and ask if they can help you to get the facility fee reduced or eliminated.

Join with We the Patients in speaking out about facility fees and other surprise charges you get. Together, patients can fight unfair billing practices!    Please speak out about your facility fee!   Let us know what happened, and join with us to help fight this unfair practice.   We urge New York State to take action to prevent facility fees, and keep health care affordable for patients. To learn more about facility fees, read here.