Facility Fees – Protect Yourself

I’m giving you fair warning – you are probably going to find this a boring post, but you need to read and take it to heart so you can protect yourself. I’ve been stung and I feel obligated to share the knowledge I’ve learned through the school of hard knocks.

There is a new source of medical billing that is rearing its ugly head all over the country and blindsiding patients. The term is called “Facility Fee.” Patients are being surprised by hospital fees they did not know they were incurring. I have found the subject matter tough to understand, so I’m going to try to break it down for you in an understandable form.

What is a Facililty Fee?
Increasingly, hospitals are hiring doctors and purchasing urgent care clinics. The hospital can then charge a “facility fee” in addition to the doctor’s or urgent care clinic’s fees. For example, if you see a hospital doctor for a sore throat, you expect to pay his bill, just like you would a non-hospital doctor. However, hospitals can also charge a separate fee. If you cut your finger and go to the urgent care clinic, thinking you are saving on emergency room fees, don’t be so sure. If the hospital owns that clinic, they may bill a separate emergency room fee on top of the urgent care clinic fee. It’s the same thing as if you made a purchase at the Clinique counter in Macy’s and a month later get a separate bill from Macy’s just for setting foot into their store.

Why is this happening?
A Medicare regulation allows separate billings of hospital fees and normal patient care fees. The rule is that the hospital also has to bill everyone else the same. Doctors are finding working directly for hospitals very appealing. They can draw a paycheck and do what they went to school for without the worries of running a challenging business.

Won’t my provider tell me up front about facility fees?
Many won’t. They know if the charges are disclosed,  you’ll probably go to another provider – which is not beneficial to their bottom line. Some providers offer slight clues, if you know what to look for. There may be a form to sign with the language “other fees” embedded in it. There also may be a small sign by the reception desk that states “additional hospital fees may be incurred.” If you don’t know the situation, that language can be misinterpreted by you to mean something else. Washington State passed a law this month requiring full disclosure of these fees to patients. In my research, I haven’t found another state that’s even thinking of going this route.

I have good health insurance, doesn’t it cover Facility Fees?
Not necessarily. From personal experience, I stayed “in network,” used the “preferred provider” hospital and doctors and still managed to get stung.  Different insurance policies are dealing with these fees in different ways. Some policies will pay the fees or they have an agreement with the hospital that it is not an allowable expense. My policy excludes these fees as a benefit (translation, I’m 100% responsible for all facility fees).

If I stay off the hospital campus, am I safe from these fees?
No! Geographic location has nothing to do with these charges. There are doctors who own their practices and rent space in a hospital building (no facility fees). Then there are hospital doctors who are off campus, miles from the hospital campus whose patients incur hospital fees. The ability for the hospital to bill these fees lies in the ownership and business relationship papers that are locked in a file folder in the bowels of some hospital administrator’s desk drawer.

So how do I protect myself?
Before visiting a new doctor or clinic ask about their billing policies and fees. Be aware that while the industry name for these charges are “facility fees,” the hospital/billing clerk may use a more euphemistic term of “clinic fees.” Before I set foot in a doctor’s office I ask the question three different ways.

  • Are there facility fees incurred during a visit to this physician?
  • Are there any clinic fees assessed with this visit? 
  • Does the hospital bill a separate fee over and above the doctor’s fee?

If I get a “no” to all three questions, I write down the date, the name of the person I talked to and what was said. I just went through this process on Friday. It took me twenty minutes, three phone calls and getting my “bitch on” to find out that the radiation oncologist I was getting referred to has facility fees.

Be aware that the doctor and office staff are sometimes not aware of how you are billed, which is why persistence and asking the same question different ways is important. There can also be confusion when asking about hospital fees. You may get an answer referring to the hospital imposing their fees for tests (like x-rays or MRI’s). Those fees having nothing to do with facility fees.

I’m recommending that you keep copies of all the documents (privacy notices, financial responsibilities, etc.) you sign with your health care provider. The sweet receptionist will tell you that you can have those documents on demand, but it can be tricky when an issue arises. Finally, find out how your insurance policy deals with facility fees.

Note: You probably recognize that this is not a normal post for me. I generally like to keep a happy, sunshine narrative going in my blog posts. It is my policy to stay away from politics and anything that might be controversial. However, since the first bill for chemotherapy has arrived, I have gone through unmitigated hell trying to sort through these unfamiliar fees. After much deliberation, I decided that I had no choice but to pass on what I have learned to you. I don’t want political discussions in the comments about how our health care system is broken, bastard insurance companies, greedy hospitals, etc. If you want to say it, I’ll be happy to listen, but let’s keep it in emails or feel free to give me a call. The purpose of this post is for you to be aware that these fees exist and it’s way too easy to get stung. A disclaimer – this is not, by any means, legal advice, I’m just passing on information to my friends.

In my next post, I plan to tell my personal insurance/facility fee story. It took me months to unravel what was going on. I also want to state that my actual care from the health care professionals has been amazing. The weather today is spectacular. Today is a good day!

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7 Responses to Facility Fees – Protect Yourself

  1. Okay, these are being billed as straight up “office visit” charges – saying I was charged the regular fee for my visit, but that I didn’t pay it. There’s nothing else listed, under any other name, and it’s for the exact amount that I’m normally charged for an office visit. I really do think it’s a bookkeeping error, in this case, but if it keeps happening, I’m going to volunteer my opinion that they need a new record-keeping staff member, STAT.

  2. Lynn says:

    Thank you so much for this valuable information. Just last week I noticed my primary care physician is NOW affilated in a BIG way with Methodist. It’s all over her office including their T shirts, lab coats, and posted everywhere around the waiting areas. Can’t wait to see that bill…I never would have put two and two together or it would have taken me a while and a few headaches….Apppreciate the info more than you know! Hope recovery is still going well, you continue to be in our thoughts & prayers!

  3. Doña says:

    Yes, We have been dealing with this for almost a year now. The Hospital in our town has virtually bought up every Dr. in this town. Now we have to go to another town for our medical needs, which by the way is 40 miles away. If we need to be hospitalized we won’t even be near our families. What our Dr.s are charging us is double the co-pay.

  4. Nick says:

    Do you have the law (might be a RCW) you cited that was passed in WA state? I’d like to read the language on that and see if “other fees may apply” on document I signed fulfills the requirements of a notification for facility fees. $130 doctor fee and $305 facility charge for a five minute visit. $305 is not covered by my insurance

  5. Judy says:

    Thank you for this valuable information. I have been on the phone all week trying to find out why I was double billed. And yes, the clinic fee is more than the doctor’s fee. It is referred to as Article 28 of the Public Health Law and this practice is also being done in New York State. It is a well kept secret until you receive the bill.

  6. Tannia Elsworth says:

    I see a specialist at the UHealth Network in Miami and they charge an Outpatient Visit fee. In one case they billed my insurance $132.00 and in the other they billed $112.00 for which my insurance says I have to pay half. I have been battling this for over 6 months and yesterday when I went to see the doctor they asked me to sign an acknowledging saying that they are a hospital based clinic and as such may charge me for services rendered in a hospital clinic. When I refused, they did not allow me to see the doctor. I am now left in mid treatment having to look for another doctor. How can this be legal? They never tell you in advance.

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