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Medicare Patient Health

Hospital Facility Fees for an Office Visit?

Occasionally I receive calls from clients questioning the “facility fee” charged by their physician and, of course, why their healthcare plan did not pay for it.

Earlier this week, NPR’s All Things Considered aired an informative six minute segment (click here to listen) explaining how a Cleveland Ohio Medicare beneficiary’s copayment bill was ten times what she had paid before for the same service. Because the provider “moved our … clinic from an office-based practice to a hospital-based setting” in the same buidling.

Hospital facility fees aren’t new. Federal regulations have long allowed hospitals to charge patients a fee, on top of the tab for medical services, to help cover the high cost of running a hospital.

What changed is hospitals “rebranding” physician practices and outpatient clinics they have purchased and billing separately for the facility as well as for physician services. That is what has happened with the Cleveland patient interviewed. It’s called “provider-based billing.” And because hospitals that bill Medicare beneficiaries this way must do so for all other patients, facility fees affect patients of all ages. 

What are Facility Fees?

  • Facility fees are often charged at physician office and clinics that are owned by hospitals to cover the costs of maintaining that facility.
  • Facility fees can range from $15 to hundreds of dollars, depending on the service you receive.

Does My Insurance Cover Facility Fees?

  • Many insurance plans do not cover facility fees or cover only a portion. Ask your plan’s member service representative whether you have to pay facility fees out of pocket.

What Can I Do to Avoid Facility Fees?

  • Sometimes it’s hard to tell whether a facility is owned by a hospital. When you call to make an appointment, ask if you will be charged a facility fee.
  • Ask the doctor if they practice at a different location that does not charge facility fees.

Sources:

CMS:  https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Approved-RAC-Topics-Items/0108-Facility-vs-Non-Facility-Reimbursement

Consumer Reports: https://www.consumerreports.org/fees-billing/surprise-hospital-fee-just-for-seeing-a-doctor-facility-fee/

Kaiser Health: https://khn.org/news/fees/

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