Did you ever go to the doctor for a simple medical procedure, pay your usual copay, and think you were done—only to get another bill a few weeks later that you weren’t expecting?
Chances are good that you got that surprise bill because of something called a facility fees. This extra expense can range between $15 – $100, and sometimes more!
Here’s what you need to know about facility fees, what they’re for, when they’re legit, who pays them, and what you need to know to challenge them if you’ve been treated unfairly.
What are Facility Fees?
Facility fees are an added charge that hospitals and health systems use to cover the cost of their buildings and staff.
Hospitals typically add facility fees when you stay there to help cover the high costs of running a full-service, 24/7 hospital. These costs may include things like equipment, staff, utilities, maintenance, and security. They claim these fees help them offer important services to everyone in need.
They have their place, and many times they’re a legitimate charge.
However, lately, hospitals have been caught charging these fees even when patients have never set foot in their facility.
Examples of Facility Fees
You could get hit with this fee if you see a doctor in a clinic or office that the hospital owns, even if the office is nowhere near the main hospital!
This facility fee is legal in many states. It comes up frequently for patients who see physicians who are a part of a large hospital system.
Even if you have good health insurance, these fees can surprise you.
For example, look at these patients who got slapped with out-of-hospital facility fees such as $503 for a pediatric visit, $488 for an appointment to get ADHD medication, and $355 for steroid injections for arthritis.
These extra fees add up fast.
One of the best ways to get the right healthcare plan and avoid scams is to connect with a representative to help you find the most affordable solutions.
Knowing more about how these fees factor into your bill can also help you make more informed choices.
Learn More: Why You Should Use Independent Doctors
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How Facility Fees Work
Normally, when you get medical care in a hospital, you get two separate bills:
- A Professional Bill – These charges cover the services from doctors, nurses, and other medical staff.
- An Institutional Bill – This covers the hospital’s costs, like the building, equipment, and utilities.
However, when you see a doctor outside of the hospital, most people expect everything should be on one bill: The professional bill.
That’s why these extra facility fees are throwing a lot of people for a loop: Hospitals are charging separate facility fees even when you’re not at the hospital, just because they own the clinic or office.
What’s Behind The Rise in Facility Fees?
Facility fees are becoming more common as hospital systems buy more clinics and outpatient practices, which is driving up the overall cost of outpatient care.
These rising healthcare costs are hitting consumers hard. People are already digging deeper into their pockets to cover higher premiums and out-of-pocket expenses, often for charges that seem disconnected from the actual care they receive. It’s no wonder that so many now find healthcare to be unaffordable.
It’s not just individuals feeling the pinch. Employers are also concerned as they face the increasing costs to provide health insurance. This ripple effect ultimately drives up expenses for everyone involved.
What Some States Are Doing
They want to make it harder for hospitals to charge facility fees outside of their main campus.
States like Indiana and Texas have already begun working on new laws to protect patients from these surprise charges.
Senator Bernie Sanders introduced the Primary Care and Health Workforce Expansion Act to improve the quality of primary health care on a national level. But the American Hospital Association’s (AHA) strongly opposes these provisions.
The AHA argues proponents of the Sanders Bill don’t understand hospital operations. They hold that the bill would reduce funding for patient care, and unfairly increase costs for healthcare providers. The AHA’s position is that facility fees are necessary to maintain services and cover costs to treat sicker patients and provide community benefits.
Learn More: Health Sharing Organizations Keep Big Government out of Your Healthcare
What You Can Do About Facility Fees
Here are a few tips that can help you manage these costs:
- Ask questions before your visit. Call the office or clinic before your appointment. Ask if they charge a facility fee and how much it will be.
- Check your insurance coverage. See if your insurance plan covers facility fees and how much you might have to pay out-of-pocket.
- Review your bill carefully. Look for any unexpected charges, and don’t be afraid to ask your doctor or hospital to explain them.
- Seek alternatives. Consider using Direct Primary Care (DPC) or Health Sharing Plans like HSA Secure to avoid unexpected charges.
- Choose independent providers. Look for doctors and clinics that are not affiliated with a large hospital system, as they typically don’t charge facility fees.
- Use outpatient imaging centers. For diagnostic tests like MRIs or CT scans, consider independent outpatient imaging centers that often have lower costs and don’t charge facility fees.
- Utilize telemedicine. Many providers offer telemedicine visits, which may not incur facility fees.
- Compare prices. Research and compare prices for services at different facilities, as some may have lower or no facility fees.
- Negotiate. If you’re aware of a potential facility fee, try negotiating with the provider or hospital to have it waived or reduced.
- Consider ambulatory surgical centers. For certain procedures, ambulatory surgical centers may offer lower costs compared to hospital outpatient departments.
- Look for transparent pricing. Seek out healthcare providers or facilities that offer transparent, all-inclusive pricing without separate facility fees.
- Explore state laws. Check if your state has laws restricting or prohibiting facility fees for specific services or locations.
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Take Action
Facility fees can make healthcare more expensive, even if you have insurance.
By understanding what they are and asking the right questions, you can avoid some of these surprise costs.
If you have questions about your healthcare options or need help finding a plan that’s right for you, contact a Personal Benefits Manager today! They can help you navigate these complex issues and find the best ways to save on your healthcare costs.
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