Medical outpatient? Ask if there's a facility fee before making appt

Hospitals Are Adding Billions in ‘Facility’ Fees for Routine Care

Unsuspecting patients find themselves at the mercy of institutions tacking on the bills

By Melanie Evans, The Wall Street Journal, March 25, 2024

Hospitals are adding billions of dollars in facility fees to medical bills for routine care in outpatient centers they own. Once an annoyance, the fees are now pervasive, and in some places they are becoming nearly impossible to avoid, data compiled for The Wall Street Journal show. The fees are spreading as hospitals press on with acquisitions, snapping up medical groups and tacking on the additional charges.

The fees raise prices by hundreds of dollars for widely used and standard medical care, including colonoscopies, mammograms and heart screening. …

Many hospital systems now get at least half their revenue from patients who aren’t admitted. By one estimate, more than half of doctors work for hospitals…

“Every appointment I make, the first question I ask is do you charge facility fees?”…

Under a bill passed by the House in December, Medicare would no longer pay hospital facility fees for chemotherapy and other drugs infused by doctors in clinics off a hospital campus… [end quote]

I’m not sure whether the bill passed by the House has been added to Medicare’s reimbursement rules but it would be a disaster for patients who will be forced to pay the fees which often run in the hundreds of dollars.

In many areas, especially rural, there may be no alternatives to providers who charge facility fees as many private practices have been taken over by hospitals.



If you’re on Medicare, it’s not too bad. My Rheumatologist is in the office building attached to a large urban hospital and charges a facility fee that’s about an 80% adder to the regular office visit reimbursement. But’s it’s just raising my 20% co-pay from $20 to $36.

It’s a completely different story if you’re pre-age-65 and paying the unlimited price gouging rates that come with for- profit health insurance. Adding a $300 facilty fee to a $400 office visit when you haven’t reached your $7,000 deductible for the year really hurts.



That’s the case now. But if Medicare passes a rule that facility fees will simply not be covered at all then patients could be on the hook for the entire fee. And Medigap insurance will only cover what Medicare allows.



That’s not how it works. If Medicare stops covering the facility fee, providers will have to stop charging it. A medical provider is required to accept the medicare reimbursement as a condition of participation in the Medicare program. If a hospital decides to not accept Medicare, CMS will stop funding their interns and resident physicians. Any politician who votes to double Medicare beneficiary out-of-pocket costs will be voted out in the next election.

The legislation mentioned in the article is a ban on hospitals charging the facility fee on chemo. Not an attempt to put the facility fee on the backs of Medicare beneficiaries.

If you have Medicare Advantage, you might get screwed. If you’re under age 65 with a for-profit health insurance plan, you’ll definitely be screwed.



Anyone else get the feeling we are reliving the 80s, when the “JCs” were constantly thinking up new ways to take people’s money for nothing?

I have told the story before, when the bank froze my savings account for inactivity, although there was plenty of activity in the linked checking account? I could not generate activity in the savings account with the ATM. I had to use a human teller. The bank charged a fee to use a human teller. So I effectively had to pay a fee, to unfreeze the account that the bank had frozen for no good reason.



I remember that, but what I remember most vividly is that part of the “new ways to take people’s money for nothing” was making political alliances with racists, religious fanatics, homophobes, etc., e.g. Reagan in 1980 launches hard and heavy into his “southern strategy”.

Taking people’s money for nothing requires the abolition of democracy.

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It only requires “JCs” that want to make more profit. A couple years ago, BMW proposed charging a subscription fee to owners of it’s cars in the UK, to use the seat heaters, that were installed in the cars they had paid for. A few weeks ago, Audi proposed charging a fee to owners in Germany, to use Apple or Android audio, or cruise control, or the hvac system, installed in the cars they had paid for.

Ford’s new head of figuring out how to ding owners with subscription fees came over from Apple, now the target of accusations of monopolistic behavior and price gouging.

It will allow Ford to have an ongoing relationship with customers after purchasing their vehicle, via services, subscriptions, and other digital revenue. Ford is generating hundreds of millions of dollars now in revenue with gross margins of more than 50 percent and Farley says he expects 10 times that in the coming years.