Facility fees continue to bedevil patients

As we've noted previously in this publication, charging patients both physician and facility fees isn't popular with consumers. Many consumers feel taken by surprise, and often rather angry, when they're hit with bills that seem to come out of the blue. Hospitals, on the other hand, seem to be willing to endure the criticism, as these fees can generate as much as $30,000 per physician each year, according to industry experts.

Medicare first began allowing the practice, known as "provider-based billing," about 10 years ago. Not all hospitals can charge the fees, but some that own physician practices and outpatient clinics meeting certain Medicare requirements get to cash in on this option. Most often, consumers are finding that they're being charged the fees at centers designated "outpatient clinics," while they might have been spared them if they'd gone to a different location within the same health system.

In the past, health plans have picked up the fees, which can range from $25 to hundreds per visit. Increasingly, however, health plans are declining to pay the fees, as hospitals have gradually increased their use of the practice. This comes as consumers pay dramatically larger deductibles, with deductibles growing on average between 30 and 64 percent over the past two years.

In recent times, hospitals have been sued over the fees, including two class-action suits filed in Washington state. However, these suits don't seem likely to slow this practice, it seems.

To learn more about this issue:
- read this Washington Post piece

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