What’s this facility fee on my medical bill?!?

Did you know that where you visit your doctor can determine the fees you’re charged for the visit? It’s true.

Many healthcare consumers are seeing a sudden rise in cost for their doctor’s visit due to facility fees. Even those with metallic-level health insurance plans are not immune to these fees, as many health insurers do not cover facility fees or only cover a portion.

So, what is a ‘facility fee?’

Facility fees are additional charges that you may have to pay when you visit a doctor at a clinic that the doctor does not own. Facility fees are often charged at clinics owned by health systems or hospitals to cover maintenance costs for the clinic.

Under our current federal law, Medicare reimburses hospitals and clinics at a much higher rate than independent physicians. This disparity has catalyzed a trend of hospitals and health systems buying independent doctors and employing them within their systems. Once employed by the hospital, the hospitals can then charge a facility fee each time the physician has a patient visit or performs a procedure.

How can facility fees be avoided?

  • Check with your insurer. Ask your insurer what their policy is on facility fees.
  • Talk to your care providers’ staff. When you call to make an appointment, ask if you will be charged a facility fee.
  • Talk to your doctor. If a facility charges a fee you do not want to pay, ask your physician if they see patients at a different location that does not charge facility fees.
  • Negotiate. Appeal to your health insurance provider to waive or lower the fee, or to cover more of the cost.

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