Warning-Dr. "Facility Fee"

[mickeyd]

What's next, "waiting room chair-use fee"?

 

[clifp]

One big reason the airlines started charging separately for luggage, aisle seats, etc rather than bundling this into the basic fares is the growth of online booking across carriers that made it much easier to shop for fares. People buy the lowest "bare" fare price, then get hit with $25 for a seat ("Oh, you want to sit next to your spouse? Well, every aisle seat costs $25 extra") and another $25 to check a bag. The booking sites (Expedia, Travelocity, etc) could take steps to incorporate this into their comparisons, but probably don't want to antagonize the airlines (further).

In 2012 the DoT began enforcing new regulations requiring airlines to include all mandatory taxes and fees in their online price quotes. The FTC has begun enforcing similar regulations against hotels, etc. More here on "drip pricing" prohibitions.

A friend of mine is the CEO of mid-size, mid-priced hotel/rental condo chain here in Hawaii and throughout the Pacific. He told me that resisted adding resort fees to their hotel for several years, but started charging a couple of years ago. He said it made a noticeable difference in their business. They were getting killed by hotels with lower room rates, but higher fees always coming out ahead in any online comparison. He said there is very little pushback to the resort fees.

My theory is once you add two or more items to the base cost of an item it is relatively easy to add more items. For instance in the case of car rental, airlines, and hotels, telephone bills there are a number of Fees (TSA, airport use, transit tax, room tax, 911, rural telephone service) that are imposed by the government, so I think it makes it easier for a private company to piggyback and add few of their own fees.

Given the incomprehensible nature of medical bills to begin with it I'd say facility fees are a logical next step.

 

[aja8888]

If you want to see a large number of additional fees tacked on to a bill, just have a look at a tuition billing for an undergrad in a university. Our granddaughter's last bill had more extra fees charges in total than the cost of the tuition itself.

 

[imoldernu]

Computer fee
Document fee
Elevator fee
Environmental fee (airconditioning)
Disposal fee... needles bandages
Carbon fee - Pencils
Sewer fee
Water fee
Energy fee (electricity)
Equipment depreciation fee
Solar energy adjustment
Supply cost... rubbergloves tissues etc
Waste removal
Hand sanitizer
Internt fee
Building insurance
Doctor insurance
Legal expense
Cancelled appointment loss coverage
Continuing education fee
Nurses wages
Receptionist wages
Automated telephone response fee
Waiting room magazines
Waiting room television
Water cooler
Professional organization memberships.
Collection costs
Lobbying expenses... (not the waiting room lobby)


etc, etc, etc... and,as mentioned in an above post... billing fees.

Many opportunities for improvement in healthcare bottom lines by monetizing expenses.

BTW... Do you understand the individual charges on your composite:
1. Electric bill?
2. Natural gas bill?
3. Telephone bill?
4. Local RE tax bill
5. House and car insurance?
5. TV, ISP bill
6. Water/sewer bill?

***** to anyone who can explain their electricity or gas supply charges.

 

[Dreamer]

I have never heard of this either and would not like it one bit if it showed up on a bill of mine.

 

[Revlefty]

I remember when I first saw "shop supplies" on an auto mechanic's bill. I asked what that was for and he said it was for the paper thing they put on the floor to keep my floor mats clean. It cost ten bucks for his dirty shoes!

 

[Meadbh]

Here is a link to a chapter from the fee schedule in British Columbia (Canada).

http://www.health.gov.bc.ca/msp/infoprac/physbilling/payschedule/pdf/3-generalservices.pdf

i) Tray fees are only applicable where the costs are actually incurred by the physician.
ii) Tray fees are only applicable in conjunction with the procedures included in the attached lists. Other procedures will be given independent consideration with the British Columbia Medical Association Tariff Committee.
iii) Tray fees are not applicable when the service is performed at a funded facility (eg., hospital, D&T Centre, Psychiatric Institution, etc.).
ii) Tray fees are only applicable in conjunction with the procedures included in the attached lists. Other procedures will be given independent consideration with the British Columbia Medical Association Tariff Committee.
iii) Tray fees are not applicable when the service is performed at a funded facility (eg., hospital, D&T Centre, Psychiatric Institution, etc.).​

As you can see, the tray fees are quite modest ($4.98 to $30.01) and are meant to compensate physicians in private practice for the cost of providing the tray (of sterilized equipment that is required for the procedure). I suspect that in many cases they do not cover those costs.

 

[JoeWras]

Governments are doing this too. Years ago, you paid your tax, and then any municipal utilities -- typically water.

Then they split out sewer and water.

Then they added garbage to the water bill.

Then they added hazardous waste to the water bill.

Then they added stormwater control to the water bill.

Etc. None of this is deductible either. I'm wondering if some day we won't have a "administrator's furniture charge" on our water bill.

 

[travelover]

I remember when I first saw "shop supplies" on an auto mechanic's bill. I asked what that was for and he said it was for the paper thing they put on the floor to keep my floor mats clean. It cost ten bucks for his dirty shoes!

Bugs me too. My oil change place has a disposal fee for the oil, but I noticed that they recycle oil for free if you carry it in. I asked why and was told they actually sell it for a profit these days.

 

[Meadbh]

Fuel surcharges on airline tickets. You pay for your ticket, and then you pay for the gas.

Sometimes I am invited to speak at conferences, where I volunteer my time but get reimbursed for expenses. I have to book and pay for airline tickets but I cannot submit my expenses until I have completed the work. I wish I could charge an administrative fee for making travel arrangements, the cost of mailing receipts, and the time value of money. Since I am ER and independent, I am planning to submit a fee schedule that covers all these costs, next time it comes up.

 

[daylatedollarshort]

This blog post has been highlighted here before, but if you missed it the first time, it is worth a read. It does not directly address convenience fees but ties in with all the extra little fees we have in life and corporate tricks to extract more money out of us. If working full time most people simply do not have time to investigate and dispute every little extra convenience charge and overcharge:

"Here in the West, a lifestyle of unnecessary spending has been deliberately cultivated and nurtured in the public by big business. Companies in all kinds of industries have a huge stake in the public’s penchant to be careless with their money. They will seek to encourage the public’s habit of casual or non-essential spending whenever they can."

Excerpt from:

Your Lifestyle Has Already Been Designed

 

[Sue J]

I just went through this with my ophthalmologist. I have been seeing her for a few years in her office on the west side of town. It's always been $178 for the office visit and $122 for the visual field test. I paid the $20 co-pay and the allowed amount for the test was $37. All very reasonable.

For my appointment in December they had a time available that was what I needed and they told me it would be at her east side office at the hospital. That's fine, I'm on the east side anyways.

I had the appointment and my visual field test. Later I got billed by the Dr and it was the same price and allowed amount as last year. Then I got another bill from the hospital billing system for $169.75. I called them and they said it was a facilities charge because at her east side office the visual field testing machine is owned by the hospital and she is under contract to the hospital for using their machine.

I was really ticked off by this because to me, the patient and PAYER, my experience was exactly the same and no one mentioned this additional fee. I called the doctors office and their attitude was, your insurance will pay, don't worry about it. I told them that I'd hate to have to find another ophthalmologist because of this and they told me that next year make sure I see her in her west side office because that fee is only for the east side hospital office!

Luckily, I had met my deductible for 2013. The allowed amount for the facilities charge was $54 so my cost was under $11. Now I know another question to ask when I see a new doctor. Lesson learned.

For 2014 we have an HDHP so I will be careful to plan for the things we can control.

 

[Accidental Retiree]

Today, an ecology fee on a gallon of paint. At the vet's, biohazard disposal fees for vaccines and the like, and $20 filling fees for prescriptions. (We order online or purchase pet scripts at Costco and save big $$$.)

 

[daylatedollarshort]

Our favorite add on fee was "undercoating" poked fun at on Seinfeld:

Jerry - That undercoating, that’s just a rip-off, isn’t it, David?

Puddy (the car salesman) - Oh, we don’t even know what it is.

 

[John Galt III]

Just got my EOB for this year's "routine annual physical" from my long time PCP. The charge was $175 and ins paid $125 or so. No charge to me. But years ago, I had to train these guys. I had to actually refuse their request for a copay at the reception window. They really wanted that copay of $20. I had to say "Look, I'm here for a routine annual physical, for which there is no copay, with my ins. Take it or leave it". They gave me the physical, begrudgingly, and I paid nothing. Their practice apparently is to engage the patient in some dialog that results in some diagnosis or other, that then allows them to change "routine annual physical" to "office visit" which is charged at a higher rate, and comes with a copay of $20. It's a shame one has to be so vigilant and confrontational sometimes.

 

[travelover]

I just got my EOB for my "free" flu shot at the University of Michigan Medical Center satellite office. Free means $67 cost to insurance, vs the $20 that I was paying at Costco the year before.

 

[ERhoosier]

In 'old days' of 'traditional' US medicine, doc charges were single fee which was high enough to cover their overhead + prof service. Then this got split into prof fee + "facility" fee, and facility fee grew to be somewhat higher for entities distinct from doc's office itself (facility vs "non-facility" site for service-see link below). Health systems began buying up doc's private offices (in part) to profit from this, and now most US docs are employees (not in private practice).

For those interested in the technical details regarding Medicare physician fee schedules, inc role of "facility" fees, here's a link to get started:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html


It's enough to make even a seasoned bureaucrat's head spin. IMHO- This transition from simple single total fee to complex separate professional/facility/etc. fee structure has made it extremely difficult to compare actual overall pricing....and comparison pricing is critical to controlling costs in any business.

 

[ziggy29]

I just got my EOB for my "free" flu shot at the University of Michigan Medical Center satellite office. Free means $67 cost to insurance, vs the $20 that I was paying at Costco the year before.

Interesting. My wife had a flu shot at a Walgreens last October when we were still on the short-term plan (which didn't cover regular exams or preventative care such as flu shots). Apparently they didn't charge her at the time of the service, but simply took her insurance card even though we were sure it wasn't going to be covered. We got an EOB in November that said the claim was denied (duh) and we may owe $31.99. Walgreens never billed us, so I assume they probably just wrote it off and moved on.

 

[Gumby]

The Connecticut Attorney General's office just released this report on hospital facility fees. Among other things, it addresses the need for better disclosure of the fact that one will be charged when a formerly independent physician practice is acquired by a hospital. Note also that the professional fees also go up when that occurs. I thought some might find it of interest.

http://www.ct.gov/ag/lib/ag/press_r...dacquisitions_hospitalbasedfacfee.doc200x.pdf