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Facility fees can skyrocket your medical bills. Here's what you can do

Facility fees are a hospital's charges for outpatient or doctor services provided in an office not owned by that doctor, and the out-of-pocket amount can be costly.
A sign showing the emergency entrance at UNC Hospitals
Posted at 3:54 PM, Jul 01, 2024

When was the last time you really looked at your doctor's bill line by line? Did you happen to run across a facility fee charge?

Facility fees are a hospital's charges for outpatient or doctor services provided in an office not owned by that doctor. The out-of-pocket amount can be costly. So, what, if anything, can you do?

Doug Eubanks lives just outside of Raleigh, North Carolina. He suffers from multiple medical issues and thought moving all of his doctors to the University of North Carolina health care system would improve his treatment by having all of his medical records in one place.

"Then I started getting hit with surprise fees outside of my normal copays for doctor visits that had no lab tests or anything extra added on, ranging anywhere from $150 to almost $300," Eubanks said.

Eubanks added that he can use his health savings account on the fees, but that quickly dwindles as it's difficult to gauge what his fees bill might be. "When you have a copay on your insurance card of $50 to go to the doctor, you expect to pay $50 just to see the doctor, and then you get another bill," he said.

Scripps News reached out to UNC Health Systems about the facility fees. They issued a statement saying, "Recent attention on these charges appears to be the result of commercial insurance policy and claims handling. Commercial insurance does cover these charges, but they are often subject to the patients' outpatient deductible or co-insurance based on their plan selection. Many patients who are participants in commercial insurance plans experience a higher out-of-pocket cost due to the health plan they have selected and the reimbursement rules of that commercial insurer."

Fifteen states have passed laws on facility fees. Of those, only a few ban them completely. Meanwhile, the federal government has stepped in, and now Medicare Part B now covers some of the fees.

In Congress, there is legislation being considered that would ban some fees and limit others.

Dr. David Eagle recently shared his sentiments towards facility fees on Capitol Hill.

"Patients came to the same building, treated by the same physician and were given the same drugs but at a higher cost to them. Patients that I had treated and followed for years, simply left," Dr. Eagle said.

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For several years, the oncologist practiced in the Charlotte, North Carolina area. When another large hospital system took over his practice, Dr. Eagle says he attempted to stand up for his patients.

"There really wasn't a solution. You know, there was no willingness to change the billing practices. I thought there may have been offers where the patient copay could be lowered somewhat ... But that never, actually never happened. We never really found a good solution," Dr. Eagle said.

Ultimately, he says he started directing his patients elsewhere, "I couldn't change the billing system after the hospital changed over, so the only thing that I could do is really give them their options. Most of the patients that contacted me just were asking for what other private physicians in the community they could see, and I was trying to direct them to the private physicians in the community that I thought could give them the best care."

Dr. Eagle now practices part-time in the state of New York, a state that has banned most facility fees. He suggests patients should be asking about facility fees when they make their appointments, and if there are potential fees, ask for a referral to a private physician.

Unfortunately for Eubanks, changing doctors is not an option. "So I started investigating moving away from UNC for some of my more common doctors that I see 3 or 4 times a year. They were either not accepting new patients or they were part of the hospital network because the hospital bought them at some point," he said.

He says he will continue to fight, hoping something can be done.

"I think the insurance companies could force the hospitals to not charge these fees to the patients through their contracts and set fees that they have with the hospitals. I also think the Insurance Commission could get involved, force insurance companies to do something. There's also the option of legislation to stop this from happening," he said.