Be upfront with patients about facility fees

While facility fees typically are subject to mostly inpatients' ire, increased hospital and health system ownership of physician practices has more ambulatory patients being asked to pitch in $100 or more for the organization's utilities and other overhead expenses. Part of the outrage expressed by patients who are charged facility fees is that they come as a surprise, and may even seem intentionally hidden, appearing as unspecified "clinical services" on the bill.

For instance, when Diane Aiello checked with her health plan to determine her out-of-pocket responsibility for her annual physical at Shea Medical Center in Pennsylvania, the insurer told her she would owe a $25.25 co-payment. When she later called Highmark to find the purpose of an extra $92 on her EOB, the representative couldn't provide an answer. She didn't learn that she was being a charged a facility fee until the practice began making collections calls to Aiello's home.

While facility fees traditionally have been covered by group health insurance when a service is performed in part of a hospital, individual insurance policies--such as the one Aiello had recently purchased--often don't cover facility fees until a patient's annual deductible is met, Highmark spokesman Michael Weinstein told the Pittsburgh Post-Gazette.

Last year, the Cleveland Clinic faced a storm of public criticism when it instituted facility fees at some of its outlying family health centers, the newspaper notes. One health center patient told the Cleveland Plain Dealer that her medical bill increased 63 percent as a result of the additional fee.

Aiello initially refused to pay the fee, but ultimately agreed to a payment plan with her now ex-practice. In addition to finding a new PCP, Aiello filed appeals with both the state insurance and health departments, which she said have not been resolved.

To learn more:
- read the full story in the Pittsburgh Post-Gazette

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