Highway Robbery

Charging a “facility fee” in addition to physician fees for a doctor’s appointment is immoral.  It is a barbaric method of gouging extra money out of people who are sick and desperately in need of a physician.

Imagine if the only physicians available to treat your condition worked 65 miles away at the outpatient clinic associated with a specialty hospital, and you received a hold-up letter:

Starting Oct. 1, we will bill a facility charge for hospital-based clinic visits…

A facility charge includes hospital expenses for a clinic visit that are separate from the cost of the medical provider.  You will continue to receive a separate charge from your medical provider for their (sic) services.  The facility charge includes costs for running the “facility” like supplies, equipment, exam rooms and other hospital staff…

Supplies, equipment, exam rooms, and support staff are simply part of the cost of providing medical care.  The high cost of doctor’s appointments is often justified because that money pays more than the doctor’s salary; it pays the support staff, the rent or mortgage, and the other costs associated with running a business.  Those costs are similar everywhere.  All businesses have overhead costs.  Those expenses don’t justify extra fees, and it is ludicrous for hospitals to think they’re special in this regard.

In an attempt to justify this travesty, the letter goes on:

All our other departments charge a facilities fee, so now the outpatient clinic will be billed the same way.

This is a standard practice for most other hospital-based clinics.

Due to recent funding cuts, we have to find somewhere else to get the money.

The fact that hospital facility fees are charged for hospital services, in no way implies that hospital facility fees are appropriate for outpatient services.

“Everyone else is doing it” isn’t an acceptable excuse when kids say it, and it’s not acceptable here.  First, because everyone else isn’t doing it.  Second, because it doesn’t matter what everyone else is doing (if everyone else was jumping off a bridge, would you do it?).

I am outraged to think that this hospital thinks they can charge every patient seen in an outpatient clinic an extra $255 per appointment.

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10 thoughts on “Highway Robbery

  1. It is outrageous. Unfortunately, it will probably be common practice everywhere very soon. I just had some outpatient surgery done in May and they did not add anything like that on then. Betcha they will next year here.

    On the other side of this, my wife works in the OR and they are stretching them thin trying to do the same or more with fewer people. Any more, even in a hospital where they are supposed to take care of you, there is little compassion … it’s all about money.

    • If facilities fees are how costs of care in a hospital are paid, then I guess we all have to bite the bullet. We all want good care, and want enough nurses working to actually deal with situations that arise.

      To charge extra simply because the office building’s owner is a hospital instead of anyone else, is what I object to. Strenuously.

  2. I just got a letter like this; I see my rheumatologist at his office in the hospital and will now be charged a separate “hospital fee” but the letter doesn’t say what that fee is. The price for his services is pretty high to begin with and I assumed it was because he was with the hospital but I guess not high enough. Is it really possible that it costs that much to provide this service? Or are the insured patients paying the difference for the underinsured or where medicare or medicaid is paying at a much lower rate? My letter stated that these patients would see no difference. There is something really wrong with a health care system where the price of services is so variable; it’s not based on the value of the service or even on ability to pay since those without insurance are often charged more than those with insurance! I am very afraid for the future of heath care in this country – where is our sense of reason?

    • My letter, too, says that kids on medicaid, kids with WA Basic Health, and kids who qualify for financial aid from the hospital won’t be charged this fee. Exactly how is this equitable? People who don’t pay much (whose care is paid for with money I earned and had to give to the government) continue to not pay, while I, who pay over $1000 for insurance every month and still pay a portion of my doctor’s bills will be charged extra. A LOT extra. The hospital fee is more than the physician’s fee. If government assistance is that lacking, then the hospital needs to stop accepting those subpar payments and require everyone to pay cash. If enough hospitals did that, people would revolt and either… Never mind. I don’t want to get ranting again.

      I think you’re right. The higher cost is mostly due to it being a hospital. There are other factors, because doctor’s visits are coded according to complexity. My family medicine doctor usually charges for a level three visit. In contrast, my rheumatologist usually charges a level four visit. My daughter’s rheum coded a level 5 visit last time, which was $200. My insurance allows allows $161 for my rheum’s level 4, but only $131 for my family doctor’s level 4 visit.

      You might want to check with the hospital on the cost of that facility fee you’re going to be seeing, and with your insurance company about coverage. I wouldn’t squawk too much about $10, but Childrens Hospital wants an extra $255 just because they happen to own the office building that the doctor works in. On my insurance policy, that $255 is treated exactly like hospital inpatient fees so it’s applied to my deductible, and after that’s met we’d owe 20%. It is appalling that I will owe $285 for a doctor’s visit after insurance has paid for the appointment. If your hospital’s facility fee is large, you might want to be prepared for it ahead of time.

      • Have you called your insurance company about it? I’m curious whether the insurance companies have negotiated down the cost of the facility fee. I mean it still sucks that you have to pay anything over the already expensive rates but it might come down to something smaller than 20 percent (after deductible) of the $255. It seems like my insurer’s negotiated rates are about half (or less) than the fee on the original bill, and because it’s in network, the provider has to just discount it and charge me the 20 percent of the allowable fee.

  3. It is outrageous. I first saw something like this when I got an injection. There was a $25 charge for the medicine and another $25 charge for administering the shot. Next time, I’ll just do the injection part myself. Sheesh!

    • In the past, my eob for my kids’ vaccines has had one fee for the vaccine and a separate fee for administering the shot. It seems kinda silly since they can’t give the shot without the medicine. The most recent time, the doctor’s office only charged for giving the shot, and there was a separate bill from WA Vaccine Assn for the medicine. I’m okay with that, maybe because I don’t want to be giving my kids their shots. Our doctor’s office charges $16.20 to give some shots, and $31.86 for others; I have no idea why there are different fees for sticking a needle in someone’s arm.

      I’ll probably spend some time on the phone today seeing if there are any private practice pediatric rheumatologists in western WA, or if we must go to Seattle Children’s. We’re already driving to Seattle, we could go a little farther to save that kind of money.

      • My pediatrician charges an administration fee for shots too, but our insurance says it’s not allowable so it just gets discounted. I’m getting the idea reading these comments that I need to be more appreciative of our health insurance … :)

  4. I ran into this same thing a year ago. The PT I was seeing for weekly lymph massage, who’s insurance billing rate was $80 from her PT office, move to the local hospital. The insurance billing rate at the hospital was over $500 for the same one hour visit. It was astounding. My insurance paid, but with my 10% co-insurance it still cost me $50, so I switched to another PT in the old practice. Then she moved away at the first of this year.

    I found a new PT who is MUCH better than either of the others, but I have to pay her $96 out of pocket, as she is out of network. At least I am not participating in the hospital scam and I feel like I’m getting my money’s worth. Since she’s out of network, and I have a $4000 deductible on my out-of-network HSA, I will have to see her 42 times before I will be able to recoup any of her services from insurance, and then they still may not pay, as I’m limited to 30 PT visits a year!

    I don’t know how we, as a nation, will ever fix our health care system. We need a do-over!

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