Facility Charge Is Latest Hidden Health-Care Fee

A friend of mine recently went to an urgent-care center with a bad sore throat. She had been there many times in the past, and the facility always accepted her insurance plan. After handing over a co-pay of $15 for urgent care, she left with a prescription. To my friend’s surprise, she received a bill two weeks later from a nearby hospital demanding a $100 “facility fee” for using the urgent-care facility. It turns out that the hospital had recently purchased the urgent-care center and was adding this fee to all bills at the center. None of this was disclosed to my friend when she was at the center. To make matters worse, her insurer would not pay the extra fee. I’ll tell you what happened later in the column. 

Facility fees are one of the biggest rip-offs the hospital industry has ever come up with. Across the country, consumers who go to “off-site” urgent-care centers or medical practices (they are not located on a hospital’s campus but are owned by the hospital entity) are being charged facility fees that in some cases are higher than the cost of care that was provided. Sadly, the fees themselves are perfectly legal despite complaints to federal and state regulators and legislators from consumers and even some doctors. 

The hospital industry defends these “gotcha” charges by saying the patient is receiving better care because the facility has all the hospital’s resources behind it. But in most cases, nothing from the patient’s perspective changed at the urgent-care center or doctor’s office after being bought by the hospital. Now, with off-campus, hospital-owned urgent-care centers and medical practices growing in huge numbers (nearly 50% of all doctors are now hospital employed), these facility fees are becoming much more common. But you can protect yourself from paying up. Here’s my advice to help you avoid these costly bills…

• Pick up the phone. Plan ahead and find out if any urgent-care facility in your area that you may want to use in the future is owned by a hospital. If it is, ask if it charges facility fees. If so, ask what that fee is. Also, call your insurance carrier and ask if your plan covers facility fees at noncampus, hospital-owned urgent-care centers and/or medical practices (this includes hospital-owned, off-campus clinics that might perform colonoscopies, mammograms and other diagnostic tests). Insider tip: Be aware that nonhospital-owned facilities or medical practices cannot add these charges. So if you want to be sure to avoid facility fees, use nonhospital-owned urgent-care centers and medical practices.

• Fight back. My friend disputed her charge directly with the hospital’s billing office, saying that she was never notified of this policy. The hospital still wouldn’t budge. But she fought on, taking it to her state’s consumer-protection bureau. This agency intervened, and the hospital dropped the charge for her. If you believe that you were not notified about a facility fee, either verbally or in writing (it’s often in the fine print of paperwork you receive), before getting treatment, dispute it. You should first challenge the charge directly with the hospital. If turned down, ask if your insurer will help you fight the charge. And if that fails, try your state’s consumer-protection agency (get contact information at USA.gov/state-consumer). Insider tip: Also contact your congressional representatives. Both your state and federal representatives can often help in these situations. Hospitals do not want to get on their bad side. And the more that political leaders hear about this practice from their constituents, the more likely the hospitals are to limit or ban these fees.