Facility Fees Not Covered by Health Insurance


Just about everyone that pays a utility bill understands how there are a variety of fees and taxes added onto the bill. The same applies to city taxes, which now generally try to pass tax levies for police, fire, street maintenance while charging a fee for picking up trash. Somewhere along the line paying one fee or tax was not enough money so agencies started tacking on to their base fees. Unfortunately, the same thing is happening in the health care industry as well.

A number of people are reporting that their medical providers are hitting them with “facility fees” that are not covered by health insurance policies. The facility fee bonanza has exploded in some regions of the country and is especially prevalent in the City of Cleveland, Ohio. A number of individuals in the Cleveland area have complained that these facility fees are costing patients $65 an office visit and even more.

One patient, which received a cortisone injection in his thumb, paid $453.00 for this medical service at a MetroHealth satellite medical office. Approximately eight months later, this same patient had another injection in the opposite thumb at MetroHealth Medical Center and was billed $1007.00. The difference in cost totals $554.00. Please note that this patient had the identical procedures performed by the same physician. The only difference was that the higher billing occurred at MetroHealth’s headquarters, but both procedures were billed by MetroHealth directly. Being a proactive consumer, this individual contacted MetroHealth to find out what was going on. MetroHealth’s customer service representative noted that MetroHealth Medical Center’s billing was higher because it is a registered hospital facility and is regulated by the government, which the satellite office is not a hospital and can bill at a lower rate.

MetroHealth is not the only large medical provider in the Cleveland area taking advantage of these add-on fees. Cleveland Clinic recently opened their Twinsburg satellite office and other regional offices are also in the making. A patient which had recently visited her doctor at the Cleveland Clinic Twinsburg facility was shocked to see that she was billed an extra $65 “facility fee” in addition to the ordinary office visit fee. Since this woman is on a fixed income, the additional facility fee she was billed is even more difficult to absorb.

Since facility fees are not covered under health insurance, patients are left to fend for themselves and are financially obligated to pay these fees. These facility fees subvert the negotiating arm of health insurance companies and are ripe for abuse. Unknowing patients, who still to this day have extremely limited access to a service and fee schedule from medical care providers to compare prices, are unaware of these facility fees until they receive their medical bill statements in the mail.

Health care reform is desperately needed as the patients described above would surely attest to. Empowering consumers with an up-front pricing schedule would allow them to have far greater control over the expenses associated with their own personal health care. But with a national health care system that is intent on avoiding any public scrutiny, it is clear that large health care providers will continue to bill for anything they can in the absence of any laws which empower patients with something as simple as the ability to price shop for the medical services they need.