Hospital Facility Fee

Patients visiting some doctors' offices andof benefits. If you're still confused, call the
urgent-care clinics are increasingly running intoprovider and your insurer to make sure you
unexpected fees, bills as though they had gone tounderstand the charge and confirm that it is
a hospital. They are becoming victims of the littleallowed by the health plan. If you feel the
understood facility fee.out-of-pocket amount you're being billed is unfair,
Facility fees are normally generated when ayou can try to appeal the provider's bill or your
patient visits a hospital or a hospital owned buildinginsurer's decision. But if the health plan's contract
for medical services. The fees, which can amountwith the provider allows for facility charges, you
to hundreds of dollars, and are billed by hospitals inwill likely run into stiff resistance.
addition to the physician practices, urgent-careWhen Jim's doctor told him to have an ultrasound,
centers and other operations.the 34-year-old customer service rep selected
Health plans may require consumers to paywhat he believed was an independently owned
emergency-room co-payments even if they didn'timaging center. The reason, scans at independent
understand that an urgent-care visit could countcenters cost him nothing under his health plan,
as a trip to the ER because the urgent-care clinicwhile hospital charges counted against his
operates in a hospital owned building.deductible. That is there would not be a facility
The facility fees are "not about driving revenue,"fee.
says Sara Larch, a vice president at Inova HealthA month later, Jim got a $773 bill from hospital
System, a not-for-profit hospital chain based inoperator Seton Health, which co-owned the
Fairfax, Va. "It's really just about getting paid forimaging center. "I just feel like I was duped," he
the cost of what we've provided."says, because there was "absolutely zero" way
Let's examine this fee in a non-medical situation.for him to know he'd be billed as if he'd visited a
It's income tax time. Your appointment with youhospital. Jim says he appealed twice, but was
account is on the 16th floor of Gotham Towersturned down both times by his insurer, Anthem
just down the hall from the office of BruceBlue Cross and Blue Shield. Jim, who had a $1,000
Wayne.deductible in his plan, ended up paying the full bill.
Two weeks later you get a bill from yourA Seton Health spokeswoman says the imaging
accountant for $500 and you pay it.center's signs include the Seton name along with
Three weeks later you get a bill from Gothamthe co-owner. She says Seton Health's rates are
Towers and Development LLC for $85.00. Why?consistent with its competitors' and it hasn't seen
You pick up the phone and when you ask whyother complaints similar to Mr. Thomson's. Anthem
the bill, you are told that you are a client of Mr.parent WellPoint says it urges members to check
Accountant and that the $85 is the facility fee foron charges and coverage in advance.
meeting with your accountant.There is no OMFS or Official Medical Fee Schedule
It's the same issue. Your accountant pays rent.for facility fees. No CPT codes or CMS guidelines.
He pays rent if he has one client or no clients.As the patient who used services, you are left on
Why should you be charged anything for providingyour own to do battle.
revenue to your accountant so he can pay theUnfortunately there isn't much you can do about
rent.these fees other then be vigilant about the bills
If you get hit by an unexpected fee, you shouldyou get from medical providers and question the
first carefully check the bill and your explanationservices provided.