Facility Fees?

doctor holding a stethoscope standing praisaeng
(photo credit: Praisaeng at http://www.freedigitalphotos.net)

It was a visit to the doctor that should have cost nothing out of pocket. The Affordable Cara Act, a.k.a. Obamacare, made it possible for my husband and I to have our annual physicals totally covered by our health insurance, not even a co-pay. The idea was to get people to have annual check-ups, and that way any potential health issues would be caught before they became serious and more costly to treat. I’d had my check-up early in the year, and it was 100% covered.

My poor husband, on the other hand, was not so fortunate. About a week ago, we got a notice in the mail that we owed $39.00 for the visit. The bill came from our nearby hospital, not the actual doctor’s office, which seemed odd. We guessed that maybe it was for blood-work that was processed at the hospital. Oddly though, lab work had always been covered 100% by our insurance. The next day we received a bill for the actual doctor’s visit – $153.

I took to the phone to resolve the two bills. After 45 minutes of trying to explain our insurance, being put on hold several times, then being told the insurance didn’t cover the physical, and the $39 was a valid “facility fee”, I was more confused than ever. The woman on the phone said something about it becoming standard to charge a facility fee to keep up with the rising costs of health care.

Well, that didn’t resolve anything, so I hopped in the car and drove to the doctor’s office. There was a line of about a dozen people waiting to be checked in. While standing in line, I prayed that I would be directed to the right person – someone that could untangle this billing problem. Finally I was called to the counter, and spoke with one of the more seasoned staff members, Pat. She listened patiently, looked over the bills I brought in, then asked me to have a seat in the waiting room while she called someone.

While waiting, I could hear Pat arguing sharply with someone on the phone, listening, then snapping back an answer. When she called me back to the counter, she explained that the bill for the actual doctor’s office visit had been billed with a wrong code, as if we had a type of insurance that did not cover doctor’s office visits. They were now re-billing it correctly, and it was cleared off our account. However, she said, we did owe the $39 for the facility fee. But I didn’t have to pay this fee earlier in the year, I countered. Pat shrugged and said she was surprised, since our insurance had been charging its customers for at least two years. So I paid the $39, thanked her for the help in clearing up the larger bill, and went home.

Googling facility fees online, I found that Pat was indeed correct – facility fees had been around for awhile. In fact, articles about facility fees went all the way back to 2009! It was confusing, but it seems that hospitals say that they are losing too much money to low-paying patients, so they are charging an extra fee at doctor’s offices that they own. When they first started doing it, the insurance companies went ahead and paid for it as part of the bill, and we weren’t even aware of it. But now they are declining to pay for the extra fee, so the hospitals just send out a bill to the patient. Pat wasn’t quite right – it isn’t exactly a bill from the insurance company, but because they refuse to pay it, it might as well be.

So that means from here on out, every time we go to the doctor, we’ll have to pay the $20 co-pay plus $39. Our out-of-pocket costs for visiting the doctor has just tripled.

Three thoughts in conclusion:

Why are doctors’ offices not required to tell patients of the extra fee when they call or go online to schedule a visit? When your car is in the shop, they are required to tell you how much it will cost to fix before they start repairs.

A lot of people are going to hold off with going to the doctor to save money, and will be sicker by the time they actually go in. How is this good for anyone?!

The healthcare system is in shambles, and will remain a patchwork of confusion and billing errors until we switch to some sort of national health care system. I don’t particularly want a single-payer system as I fear the quality will probably go down, but our current hodge-podge of health insurance is bankrupting families and causing people to not go in for medical treatment when they need it. We are witnessing the slow, agonizing death of free-market healthcare coverage.


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