Warning-Dr. "Facility Fee"

[imoldernu]

Our doctor recently became affiliated with the regional hospital, that now handles the billing. Unbeknownst to us, this caused all of our doctor visits to now have an added $49 "facility fee". Since our doctor charges $67 for a visit, this has now become a total of $118. If we have multiple visits, it's that extra $49 each time

Since the billing statements that usually arrive after the doctor visit, come after the the insurance company has made payment, and are often quite complicated, with codes and medical terms... the actual cost can get buried.

It was only after we received accidentally a bill for $5978 for a stress test, (before insurance paid) that we began to dig in to the actual expenses and found the "facility fee" from the doctor's office.

You probably already knew about this, but for those of us "geezers"who struggle to keep up, it was a surprise. If you're caring for an older relative, this is the kind of thing that often goes by the boards.

You may be able to avoid this fee, but it might mean switching doctors.

Many search results for "doctor facility fee" ... here's one:

https://www.premera.com/documents/026672.pdf

Here's a quote from another website that's even worse...

Early last year, a friend of mine consulted a highly recommended doctor in Providence. She liked the doctor and got the care she needed. But she canceled a follow-up appointment and says she will never return to that practice — because she’s furious about what showed up on her bill.
Listed beneath the expected charge for physician services ($162), she found an item labeled “Clinic Visits” with a $370 price tag. When my friend called to find out what the $370 was for, she was told it was a “facility fee,” a sum charged simply because the medical group is owned by a hospital. No one had warned her, and this makes no sense.

 

[W2R]

I never heard of such a thing! Do insurance companies pay this? Or maybe, is this a way for doctors to circumvent the negotiated fees set by insurance companies?

I would be pretty upset if I ever saw that! So far, so good.

 

[imoldernu]

"I never heard of such a thing! Do insurance companies pay this? Or maybe, is this a way for doctors to circumvent the negotiated fees set by insurance companies?

I would be pretty upset if I ever saw that! So far, so good."]I never heard of such a thing! Do insurance companies pay this? Or maybe, is this a way for doctors to circumvent the negotiated fees set by insurance companies?

I would be pretty upset if I ever saw that! So far, so good.

Medicare pays....
The insurance companies pay...

Except for the fact that the "facility" screwed up and sent me the bill before the insurance payments were made, we would have received a "net cost to you" bill with a zero balance... and come away, fat dumb and happy.

It's the law, and as long as it's legal, all of the care providers are happy. It's just the end result that we see every year... health cost premiums going up, up, up... Obamacare or not.

out of sight, out of mind.

edit... another link:http://www.kansascity.com/2013/12/29/4719471/facility-fees-add-billions-to.html

 

[aja8888]

I think this should be added to the many businesses that are arbitrarily adding creative fees to consumers' bills these days. It's kind of like our home/auto insurance fee on our recent renewal called "renewal fee", which, when I inquired with my agent, no one could tell me what that $79.00 fee was for.

After prodding my next door insurance agent who we don't have a policy with, she said it was a fee for the commission paid to the independent brokers. Nice, now we are paying seller's commissions and the insurance company is not?

 

[daylatedollarshort]

We had a "facility fee" added to a vet bill that doubled the bill. Smooth move on their part as they lost us as customers forever after that. I had purposely called around and price shopped before that for some routine vet services, and they conveniently left off the "facility fee" when they quoted the price.

We've been eliminating many creative fees from our lives since we semi-ERed and have more time to compare prices and examine bills. I just got a renewal email today for a subscription for a service for our business, and the price turned out to be $20 more than the annual subscription rate on their web site.

I sent a little email asking why they were trying to charge loyal customers more than their published rates.

 

[Gatordoc50]

Sign of the times. It is aggravating when someone promises you something while knowing it is a lie, and then tries to pass it off as a misunderstanding.

 

[braumeister]

This sort of thing is becoming rampant in a lot of areas.
"Resort fee" added to your hotel bill because they have a pool.

The one that boggled my mind the most was last year when I rented a car at the Seattle airport. As I recall, there were six separate extra fees added to the cost of the rental, none of them really trivial amounts.
That said, I can almost understand it, because if you can't soak the tourist, who can you soak?
But adding something like this onto a doctor's bill for an office visit is really over the top IMHO.

 

[travelover]

...........The one that boggled my mind the most was last year when I rented a car at the Seattle airport. As I recall, there were six separate extra fees added to the cost of the rental, none of them really trivial amounts.
That said, I can almost understand it, because if you can't soak the tourist, who can you soak?............

I hate those fees , too. When I can, I take a taxi from the airport to an off site rental office, often savings hundreds of $$. You can often pick the car up remotely and return it to the airport for the same price as returning to the off site office where you picked it up.

 

[Chuckanut]

Here's a great one. When filing her income tax a relative decided to have the $20 tax-prep fee deducted from her refund. When we read the fine print we found that the institution that took care of that was charging $29.99! Almost $30 to pay a $20 fee!! She charged the fee to her credit card instead. No fee for that.

 

[daylatedollarshort]

Another creative fee - I just opened the mail today and with an offer from Financial Engines to "manage" our 401k money for another 0.50% fee, on top of the mutual fund fees.

Hmm, a management fee of 0.50% a year to tell us to have a 60/40 mix of stocks and bonds in professionally managed mutual funds. Where do I sign up!?!

 

[MichaelB]

As I recall, Medicare physician reimbursement rates are higher for hospitals than private physicians. This is to compensate hospitals because they are required to provide emergency services to everyone, regardless of insurance coverage or ability to pay.

That is what this "facility fee" sounds like. The pressure will be on them to drop these charges because the number of uninsured services is declining as more people get insurance and Medicaid coverage. CMS has already begun reducing direct transfers to hospitals that paid for uninsured care.

Hospitals are not cost centers, they are revenue generating operations. They are more focused on growing the revenue streams because the money to pay has always been there. It would be nice if this were the beginning if the end of that phase of their business cycle.

 

[ziggy29]

This sort of thing is becoming rampant in a lot of areas.
"Resort fee" added to your hotel bill because they have a pool.

This is happening almost anywhere there's someone else who would take a "cut" of the base charges. "Add-ons" may be money in their own pocket, not to be shared with other entities.

Also, they like to be able to quote lower prices and the junk fees are often not included in the quotes or ads.

When my wife was selling cruises, a rampant practice was to not raise base fares, but to pass on price increases through increasing junk fees (and not just the required government port taxes and such). Why? For one, they quote a lower fare in their ads and say "fees not included", which can increase the cost by 50% or more; and for another, junk fees were not commissionable.

 

[aja8888]

Hospitals are not cost centers, they are revenue generating operations. They are more focused on growing the revenue streams because the money to pay has always been there. It would be nice if this were the beginning if the end of that phase of their business cycle.

I'm not sure what you mean by stating hospitals are not cost centers (??). My long experience running revenue generating operations makes me curious who pays the fixed and variable costs at hospitals? I mean, they have utility bills, taxes to pay, building maintenance, staff, employee burden expenses, and on and on. I suspect the reason a hospital went out of business around here recently was a combination of not enough revenue to cover costs.

 

[John Galt III]

I had to go to the ER many years ago for something. Verified at the front window what all my costs would be, including my $50 copay. Sure enough, got a "tack on" of $150, billed to me, not the ins co, for some "doctors group". Called to protest the extra $150, and they took it off the bill. I bet a lot of folks just pay the extra fees, and don't think they have a choice.

 

[travelover]

I'm not sure what you mean by stating hospitals are not cost centers (??). My long experience running revenue generating operations makes me curious who pays the fixed and variable costs at hospitals? I mean, they have utility bills, taxes to pay, building maintenance, staff, employee burden expenses, and on and on. I suspect the reason a hospital went out of business around here recently was a combination of not enough revenue to cover costs.

I'd love to know the details for your anecdote. In the US, we pay over $8000 yearly for every man woman and child for health care. It is beyond mind boggling that such a large portion of our economy is so opaque.

 

[imoldernu]

Here's short article that may be worth reading. It explains the "Medical Group" thing, and offers an overview of possibilities for the future.
Health Insight: Don’t be blindsided by doctors’ ‘facility fees’ | Providence Journal | Rhode Island News, sports, weather & more

Interesting note included... some physicians groups, (Facilities) only charge the fee to Medicare and insured patients. So in some cases, it might not "pay" to be insured... but we all pay for medicare, in one way or another.

 

[Chuckanut]

Sure enough, got a "tack on" of $150, billed to me, not the ins co, for some "doctors group". Called to protest the extra $150, and they took it off the bill. I bet a lot of folks just pay the extra fees, and don't think they have a choice.

How unreasonable of you! Somebody has to pay for the doctor's new Mercedes.

 

[scrabbler1]

I hate those fees , too. When I can, I take a taxi from the airport to an off site rental office, often savings hundreds of $$. You can often pick the car up remotely and return it to the airport for the same price as returning to the off site office where you picked it up.

I remember learning about this type of fee back in the early 1990s. I read about it in Consumer Reports. One time, my mom and I happened to fly into Houston as passengers on a corporate jet (Corporate Angels Network, my mom had cancer) and the company drove us to a nearby off-site car rental agency we had chosen. Thanks to having read the CR article beforehand, I knew to tell the agent at the rental counter that we did not use the airport shuttle bus to get there from the ariport so she could strike out the fee, saving us several dollars.

 

[Gumby]

To get back to the OP, I agree that the facility fee is outrageous. It is absurd that I can go to my doctor's office one month and pay X. Next month, I go back, see the exact some person in the exact same facility using the exact same equipment for the exact same procedure and pay X+$1000, simply because a hospital has acquired my doctor's practice and he is now their employee. It's actually worse than just the facility fee. When insurance companies negotiate reimbursement rates for procedures, hospitals get better rates than independent physician practices because hospitals have more negotiating leverage. So not only must you now pay a facility fee for a "facility" that is miles away, but the rates for the specific procedures done by your doctor go up to the ones negotiated by the hospital.

Some states, including mine, are trying to do something about this. At the very least, people need to be clearly informed that it will be charged so that they can go elsewhere if they object.

Some interesting links to articles exploring the topic:

Day 2: ‘Facility fees’ add billions to medical bills - KansasCity.com

Healthcare’s hidden costs can take patients by surprise - Healthcare Reform - MiamiHerald.com

http://www.ct.gov/ag/cwp/view.asp?A=2341&Q=535838

 

[MBSC]

Here is an article from October, 2009 stating the facility fee charge is the result of a change in Medicare rules from nearly a decade earlier.
'Facility Fees' Are Surprise Cost For Many Patients - Kaiser Health News

 

[Gumby]

As I understand it, the only Medicare rule is that IF they charge a facility fee to Medicare patients, they must charge it to other patients. It doesn't mandate that hospitals charge a facility fee. They shouldn't be charging it to anyone. It is deceptive and intentionally so.

 

[obgyn65]

Patients can always contact the Boards if they have evidence of wrong doings.

Sign of the times. It is aggravating when someone promises you something while knowing it is a lie, and then tries to pass it off as a misunderstanding.

 

[samclem]

Also, they like to be able to quote lower prices and the junk fees are often not included in the quotes or ads.

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.

 

[aja8888]

Patients can always contact the Boards if they have evidence of wrong doings.

Yeah, getting the "evidence" is the hard part. They can write their Congressman too.

 

[Theseus]

Had a $10 fee assessed by specialist's billing department for filling out paperwork "required" by FMLA administrators, which was a 3rd party contracted by megacorp. Insurance co ignored it since apparently they didn't think it was necessary, and well, I ignored it too because I felt it was both an unnecessary service and charge. Not sure if they huffed and puffed for the last time and gave up about it, or if I'll get a call from a bill collector for it. If it does go to a bill collector I really don't give a rats @ss, in the unlikely event I ever need a new line of credit I'd be happy to explain that one blemish on an otherwise perfect credit score.