Why Was My Doctor Visit Suddenly So Expensive?

The facility fee may be to blame for the added costs of a doctor visit.

Comments: 257

  1. Since so many medical practices are hiring doctors , thèy are assured of a certain income and saving the cost of maintaining their private offices . The corporations can ha e many physicians in a facility and each patient who must wait to be seen until an office is ready we have no option but to be taxed (and that is what it is) to see the doctor we need. Doctor/patient relationships were always encouraged so your doctor knew your medical needs. Now it's obvious that is no more. Is this good medical care? Big corporations are forcing private physicians to join their clubs. Not every medical visit is an emergency, sometimes a follow up is necessary. So many medical conditions will get worse .....when we have to decide whether we should return for a follow up, or if we can afford to. Seeing a doctor is not like a choice.

  2. I was charged a facility fee of over $400 at an NYU office where my doctor works. My insurance company (Aetna) rejected this fee, making me fully responsible to pay it. I determined it was tied to being weighed and having blood pressure taken (both of which anyone can do at home or at the drug store). For subsequent visits I declined these procedures when checking in and was not charged the facility fee again. Perhaps other readers will be able to do this, worth a try.

  3. @Alan Raderman- wow, thanks 4 sharing...-this is probably amazing practical advice, but it's also a completely absurd situation...

  4. @Karen True that.

  5. @Alan Raderman Yes. A nurse at my doctor's office told me that they need to do at least two checks to receive full reimbursement. This is with Medicare and, thanks to my Medicare supplement, I personally am not charged for the facility fee, but the charges show up on my statements. On a related topic, I had orthopedic surgery this year and was provided a brace by the surgeon's office. I was billed $10 in supplemental fees; their total charge was $80 for a brace I could buy online for under $30. I complained, telling them their charges were outrageous and excessive. Explanation was that everyone in the food chain (surgeon's office, hospital, billing company, etc.) added on a fee. The complaints worked, though, and a few months later they they sent me a refund check. As part of the follow-up, I went to a bone fracture clinic in the surgeon's office. First visit was fine. Second visit (even before they had lab results), they started pushing two very expensive medications that would cost me at least $1500 a month out of pocket with no mention of other reasonable alternatives. I never went back. The surgeon was excellent, but the practice had recently been incorporated into a large for-profit hospital system that had recently acquired the formerly "non-profit" hospital. There aren't many hospitals in rural western NC, so there aren't a lot of choices.

  6. It has become a common practice for hospitals to buy private medical practices, specifically to charge the extra facility fee, in ADDITION to the usual practice charges. The services provided are identical to what were provided before. The new facility fee income is then shared by the hospital and the prior private practice (via an inflated sale price). This is a classic example of the healthcare industry ripping off consumers by legally adding huge additional charges for the same services. Should be illegal, but it’s not.

  7. @Michael Saxe, M.D. I don't think people appreciate the pace that this is happening. Hospitals who who present as noble non-profits with "small operating margins" still manage to somehow continually gobble up private practices and smaller hospitals. In areas like northern Vermont, where there's no longer a lot of options outside of the University of Vermont network, that can have uniform consequences for both patients and providers.

  8. @Mike the non-profit status allows these big hospital groups greater cash-flow via tax subsidies. This gives them a major advantage over businesses that actually contribute to the federal, state, and local tax roles. We see the same thing with universities who charge top dollar, build up massive endowments, and use that to buy up local real estate pushing out others along the way. Of course their administrators are rewarded with million dollar salaries and benefits. There should be a law that reins in this kind of predatory behavior if an organization doesn't have to pay the taxes the rest of us labor under.

  9. @Michael Saxe, M.D. When Medicare started to enforce its cuts to hospitals in an attempt to lower costs, they came up with these facility fees to make up for the loss. My son has a terrific plan from his employer but they don't pay these facility fees while my Medicare supplemental does pay them. This is just more of the shell game of the health care industry we have. And as much as I am glad I have Medicare I pay a lot for the private insurance supplemental. When people say they want Medicare for All, they really have no clue what they're talking about. Our Medicare system is not even remotely similar to any European or Canadian system lauded by so many. Our politicians and presidential candidates are not telling you the truth about their so-called Medicare for All plans - which are still shell games. A true single payer system is based on taxing individuals, putting those revenues into a bucket identified as health care, and then paying medical providers out of that bucket. The fundamental purpose of single payer is to remove the cost burden on employers so that businesses can pay employees higher salaries as well as free individuals from having their health care linked to job security.

  10. What happens when your health is for-profit.

  11. These fees are usually only at hospitals, most of which are “non-profit”.

  12. @Steven Caplan “non-profit” is a financial accounting category that does not mean the hospital does not make a profit as normal people use the word. They can make as much money as they can manage and spend it on almost anything, including salaries (certainly including executives and administrators), buildings (which can be extremely fancy), equipment, buying more medical practices, etc. What they can’t do is pay dividends to shareholders.

  13. Soon they will be adding an air fee, because all patients breath air while at the hospital. Maybe they will give a slight discount to those patients bringing their own oxygen tanks.

  14. Does Medicare cover a facility fee?

  15. No, Medicare does NOT cover facilities fees. I know that because I used to go to a practice that charged facilities fees and neither Medicare nor my other insurance covered that extra expense. (Needless to say, I've moved to another physician unrelated to a hospital, who does not charge a facilities fee.)

  16. You can tell this is written by a doctor. He’s got all the empathy of a pet rock. Just reading this emotionless article is enough to tell you why our healthcare system is a disaster. Facility fees are nothing more than yet another money grab by hospitals. Just another version of the $100 aspirin.

  17. @Mike L This is unfair. Whatever the author's empathy level, the Times printed this piece: I learned to be aware of such an absurd fee and the author had the integrity to discuss the practice. I despise the whole healthcare gambit in America. But please give the human being some human credit, please.

  18. That’s a cheap shot at the author physician.. You want unnecessary empathy get a dog, or inappropriate outrage, watch Bernie Sanders. At least this article is factually accurate for the most part which is all you should expect from an article. Prior NYT articles on this subject have inaccurately reported that the doctor pockets the extra fees. At least the author here got that right. The doctors are employees and are on salary in these hospital owned practices. The article is inaccurate in stating that the practices are bought above market value because of this future increased fee. There is no way the bean counters increase their offers based on that. The buying of a private practice is based on the financials of a practice and believe me these corporations don’t cut anybody a gift. It’s a buyers market as physicians are fed up with the difficulties of managing a practice with the obstacles of hospitals, pharmacies, urgent care centers and electronic records. These facility fee arrangements were created by the hospital lobby and the Obama architects to annihilate private practices. From one of the few physicians still in private practice.

  19. I have been a physician since 2000 and I feel that hidden fees and surprise bills such as described in this article are one of the major causes of distrust and loss of respect for physicians and the healthcare industry in general. I don’t blame people for going to Dr. “GOOGLE” or other dubious alternatives found on the net. I also think this leads to a cynical view that all medical providers are there only for the salary and lifestyle. Most who actually provides direct medical care would not contemplate billing practices described in the article if the transaction was solely between Doctor/NP/DNP/PA and patient. Unfortunately like our current political climate the complexity and unbalanced incentives of our healthcare system divides our profession and there is a lack of coordination and enthusiasm to fight for change within our professions. All direct care healthcare providers should demand a seat at the table and a role in eliminating predatory billing to the most vulnerable in our society.

  20. @JCOMD Exactly! These fees are not caused by the many good people who actually provide health care. They are caused by the financial tech operators, and the hedge-fund/private-equity/extractive financial industry behind them, that have turned the health care finance system in a rent-extraction mechanism for private wealth at public expense.

  21. @JCOMD Soon no Senior Citizens will be able to afford their doctor visits, medicines or food since Senator Joni Ernest is talking cuts to Social Security because of huge budget deficit at town halls in Iowa.

  22. @JCOMD. Glad to hear this. Perhaps all the physicians who operate out of hospitals that charge facility fees could collectively demand their removal, and strike if they are not. Patients would see that their physician is on their side, and hospital administrators would find out who really is important in healthcare. (Hint: it’s not the guy in the corner office.)

  23. My husband makes twice yearly visits to the Christus St. Vincent heart and vascular clinic. In the past, he has begun the visit with a pacemaker check and then had an appointment with his cardiologist. But recently, the clinic has refused to put the checks together. This is not only an inconvenience to the patient, but 2 visits instead of one means two "facility" fees. This seems dishonest to me.

  24. @Kathleen Adams It sort of is. The costs of health care in the USA are very high by world standards. There is no perfect system, but yours is definitely an outlier, delivering comparatively poor outcomes for outrageous costs and with many poor folk marginalised.

  25. @Kathleen Adams Turn them in to your State Attorney General.

  26. For a recurring sinus issue, I've had to get two nasal endoscopies: one in a hospital doctor's office for ~$3500, and one in a standalone office for $220. The procedure is essentially a few minutes of waiting for lidocaine gauze to numb the nasal passages, and then looking around with a camera for another few minutes. In the hospital, it was completed by a resident, quickly checked by a more experienced doctor. Worth noting that the resident was probably making a meager salary, which is an accepted part of the training experience. At the other office, it was conducted entirely by an experienced physician for a fraction of the cost. My current deductible is so high, that I see every dollar of my care, so I actually shopped around this time: it took under an hour to find this doctor and ultimately save thousands of dollars for the exact same simple procedure. I'm no Republican, but I remain wary of political candidates who simplistically vilify pharma and insurance, but leave hospitals off the hook, when they may well be the biggest culprit in our healthcare cost crisis. They should not be continually allowed to hide behind a more noble narrative.

  27. I am also frustrated by the omission of hospitals and other providers from the cost discussions.

  28. @Mike When I saw that my son (who has a very good employer based plan) was charged a facility fee and his insurance company rejected it, since I use the same facility I was curious as to whether or not Medicare and my private insurance supplemental does pay it. Sure enough my private insurance does pay it. So I asked the hospital rep where our internists practice what it was all about. (It was new a couple of years ago - they never charged a facility fee before.) She told me that when Medicare cut how much they would reimburse hospitals, to make up for that loss, they started charging facility fees. She was frank. So our health care system is all a shell game.

  29. But pharma do charge exuberant prices for drugs, how is it different from the hospital's practice? And private insurance-based system allows these practices to exist, because apparently insurances are not fighting these charges as Medicare does. For private insurances is easier to increase the premiums and deductibles that to fight for reasonable pricing. Power of negotiation is a big plus for single-payer system, otherwise you need to introduce price control.

  30. This is why people do not seek health care period. Who can afford to pay for grand pianos in healthcare facility lobbies when you’re diabetic and need to buy insulin, have a heart condition and need an echocardiogram, or in orthopedic pain and need a CT scan or an MRI? So unfair. (and I served as an RN for decades)

  31. I’ve resolved that as of January 1, I’m not going to a doctor unless it’s an heart attack. Everything else, it’s the walk-in clinic at my grocery store. Ironically, I worked in government 30 years so I’d have good health care later. But it’s dissolved into thin air.

  32. @Angry Person You're right. I'm a govt retiree as well. I had to stop using the prescription part of my plan because it's cheaper to use generic coverage available to the public. Under our health care plan one prescription copay went from $20 to $70 In one month. They dropped the medication from Tier I to Tier II coverage. I was able to get the medication at my local grocery store for $20. They can do this to any drug any time. The medication is not one I can be without, I need it to live. I'll be looking closely at open enrollment weighing plan cost vs. benefits. I made the mistake of looking at drug cost and coverage last year to make a decision; I won't again.

  33. This answer is not, unfortunately, properly answered. It is true that a hospital could (and has) doctors that practice in the hospital or at nearby buildings which are part of the hospital campus, taking care of patients in an outpatient or inpatient basis, based on their health needs. It is for this purpose that the facility fee exists. However, hospital networks are now using the facility fee as a profit-maker. Many hospitals have "expanded" into office space that, contrary to a true clinic, consist of nothing more than desks, receptionists, and exam rooms. Outside of consultations it is often the case that *absolutely no* care can occur, i.e. no emergency care, no day surgery, no health procedures, not even X-Rays or lab work, and certainly not a single bed can be found in these "facilities" which are often miles away from a hospital, though their buildings might carry the name "hospital" alongside of a disclaimer of no emergency care in the premises. Charging a *hospital* facility fee in this case is nothing more than abuse and profit-making. A hospital chain that engages in such practices should be shunned by patients, and investigated (as they are in MA) by the attorney general. (Such fee is often not charged to Medicare, btw, as it could be tantamount to fraud).

  34. @Yoandel You apparently have other hospitals from which to choose. Look at cities outside major metro areas - consolidation has resulted in one hospital and often none.

  35. My daughter doctor at a big university hospital told me that they charge these outrageous prices because there are some Cadillac plans that pay these fees or Medicare pays them and therefore they charge everyone...so that they can pick up revenue where they can

  36. It’s revenue management pure and simple. Airlines charge extra for bags and choice seating in coach and hospital clinics charge a facility fee. Avoiding these fees means we all have to plan where, when and who we go to for medical care. Thanks for giving the “heads-up”, I’ll be watching and asking at my provider! It’s a shame we need to be so vigilant. Do the patient no harm, physically but not monetarily?

  37. I went to a GP practice that I loved until I moved out of state. Reasonable charges, generally available physicians. Then I moved to another state and had to find new doctors. What a shock I visited a doctor who was part of a large hospital based practice for a simple bacterial infection. The doctor immediately recommended in-office surgery. It was too painful so it wasn't completed. A few weeks later I was admitted to the same hospital for a different issue; while there they also gave me an antibiotic to cure my bacterial infection. At discharge they said my fin'l responsibility was $875, I paid. I have Medicare A and private ins and I later found out I only owed the Medicare deductible. it took 6 months of calling to get a refund. Meanwhile their first doctor turned me over to a collection agency for an office visit charge because she didn't do the surgery. Going to them also put me on their mailing list for every imaginable unneeded test They started mailing and emailing. I'd have to be bleeding from a gunshot wound with no other facilities available to return to them. I eventually found another independent GP. At my initial visit he asked how long it had been since I had various tests and was genuinely concerned that I not get in a situation where my ins. company wouldn't pay because of overuse or frequency. His type of practice is vanishing as they retire.

  38. This is a difficult social, economic and political problem with a long history, starting in the 1950's when medical billing formulas were first used. In the late 1980's, Medicare created our current system of relative value units for physicians, which was integrated into the underlying system that was treating doctors (part B) and hospitals (part A) differently. For every medical service or test, the fee structure is calculated as direct work, (time and effort of the doctor or nurse practitioner) and an amount that is really "overhead", including office staffing, malpractice insurance, rent, heat, depreciation, cost of the equipment. In a private doctor's office, the overhead is lower than if you go to a doctor working in a large hospital practice environment. Decades ago, most outpatient medical care was in smaller office practices and most complex tests were performed only in hospitals, so patients did not encounter major Parts A-B cost differentials. Part A (hospital) fees reflect care to indigent people and greater costs of large campuses. Now, is it common for the public to see this differential, since many medical practices compete with hospitals to provide the same service. Medicare has worked to bring outpatient fees under Parts A and B closer, but there has been much pushback from hospitals against that on the basis that care for the broader community needs the subsidy. Also, corporations that run hospitals do not want to lose this source of profit.

  39. Please consider the scope of the overhead that hospitals have that a doctor's office does not: psych holding, morgues, labs, pharmacies, discharge planning staff, cafeterias, community education events, the poor without insurance, Joint Commission accreditation, emergency rooms, training programs, research, and on and on and on. Comparing hospital clinic based care to that of a doctor's office is comparing a pebble to a boulder.

  40. @MMP Not to mention two flat-screen TVs in every patient room, faux marble flooring including in the elevators, elaborate landscaping, ginormous florist-provided arrangements in the hallways, Super Bowl ads, putting their names on concert venues and baseball stadiums, and the 8-figure salaries for their CEOs. All adds up, don't you know.

  41. @MMP - Then why are many procedures that could be done in a doctors office done in a hospital?

  42. The hospital I work for even prints its name and logo on disposable paper coffee cups. What a waste.

  43. Elizabeth Warren is continually accused of trying to raise taxes for a health service similar to those in most of the Western World. The taxes would be less than Americans pay for insurance. In Britain we pay National Health Insurance while in employment. A part of general taxation completes the payment for our National Health Service. Apart from a small fixed charge for prescriptions for those who are working it is free at point of use. The total cost is less than half the cost to Americans for a service which is less able to keep its citizens alive.. The average lifespan in the major countries of Europe is longer than Americans. I am 91.

  44. @irdac, Such important points. Americans do not seem to realize that we pay at least twice as much for healthcare as other developed countries. That might be OK if we ended up twice as healthy and lived twice as long. But we are far less healthy and our lifespan is shorter. Twice as much for a demonstrably inferior product. What other industry could get away with it?

  45. @irdac - Here are the per capita figures for health care costs in 2016 in PPP dollars from the OECD: US - $9507.2 UK - 4192.5 We paid 127% more.

  46. @irdac Of all the candidates, I think I'm a Warren supporter, but our system is so entrenched and expensive that to make any real progress toward true affordable care, hospitals are simply going to have to less money. Any plan will have to go through a gauntlet of being tarred as devaluing legions of democrat-voting nurses and doctors. And with hospitals as major employers in many congressional districts, it's difficult to imagine all of our lawmakers doing what's best for the country. By the time Barack Obama's Affordable Care Act passed, there was nothing more affordable about care. I have worthless insurance: $7,000 deductible with half of the $500/mo premium paid for by the government.

  47. Just another reason for (Improved) Medicare for All.

  48. @Charles pack ..Except that as a medicare recipient, I am also charged a facility fee..no getting around them seems.

  49. @demilicious - I would bet that IMPROVED Medicare for ALL as proposed by Bernie and Warren would not allow this.

  50. But Medicare covers it and private insurance doesn’t. That is one of the “wastes” that needs to be ferreted out.

  51. While all of the candidates like to bash insurance companies (for underpaying) and drug companies (for overcharging), I think a closer look needs to be taken at both doctors and hospitals. They, too, overcharge in many situations.

  52. I've been seeing TV ads with a supposed doctor exhorting viewers not to allow "government rate setting" because otherwise you might not have doctors anymore! Wow, do doctors think this makes them look anything but money-grubbing shills?

  53. @Anne Hajduk You can define a price that you are willing to pay me for a procedure but you cant force me to see you for that price. If I charge a lot for something, please dont come to my office. No one can force a patient on a doctor and pay whatever they want. It is a free country and will fight this till the end.

  54. @Anne Hajduk Most doctors are employed by large health systems who negotiate prices and do the billing. They are big businesses with a strong profit motive. Docs in general just want to help you and have no idea what you will be charged by the health system

  55. Hmm. A large American hospitals provider brought these charges to London years ago. Sure we have 'facilities fees' - which were usually far more than the physician's fee I charged - concurrent charges like for e.g. Band-Aid removal were common, too. The hospital insisted that one of their nurses was present for all in-office surgeries, no matter how minor. That seemed to involve filling in paperwork (that I never got to see) on the basis of reproducing the history I had already taken regarding allergies, current medication and general health and then holding the patient's hand whilst I worked. This incurred a 'nursing charge' on top of the facilities fee which again, was MORE than my physician's fee. NHS (state provided) hospitals in the UK also take private work into their labs. The difference in charges was - in my time - staggering: Private tissue biopsy report £(GBP) 895 (about $1120), NHS £135. Private CBC blood count and film £40, NHS £0.40 (sic) although the NHS lab would bump it up a couple of dollars to cover the office time and fax call. Actually, the NHS labs didn't need to grow this kind of work, anyhow. I never understood why insurers would wear these fantastic rip-offs. On the occasions that I raised it with some of them, they didn't want to know. Insurer and provider had a stable arrangement and the boat wasn't to be rocked. After all, they were both doing fine - it was patients ultimately picking up the tab for this cosy carte activity.

  56. Anytime cost can be passed to employers or patients the,selves, it is a sweet deal to insurer or government. They take their cut and it’s the poor patient (or employer who is paying high premiums) who pays. It’s time for Medicare for all.

  57. I have had this all too often, even with Medicare. So frustrating, and so wrong.

  58. I work in an independent health care private practice NOT owned by a hospital system ...yet. The reason practices are sold to a hospital (which then charges these "facility fees") is the cost of maintaining everything - staff, building maintenance, paperwork filing, is so expensive and takes so much time away from what we went into medicine to do - take care of patients. When a hospital system buys a practice, they will often take over the billing and filing part, which requires intimate knowledge of the coding requirements and fine details of documentation that result in insurance companies actually paying for your time and care, rather than one denial after another, requiring 3 times the time and energy than what you actually spent on the patient. When we can get rid of all the different requirements from multitudes of insurers - and have one form to file, one set of requirements for documentation and one formulary for medications with clear coverage information for me and my patients, we might be able to actually be independent and not become just another hospital employee drone.

  59. @DJ! - Just one of the many strong arguments for Medicare for All.

  60. @DJ! I had a fantastic but elderly sole practitioner primary care doc for a while until he retired - we called him "Dr. Old," and his office was in his modest suburban split level home. It took three admin ladies to handle appointments and billing for this one small-scale doc. It was great for the patients, as he could take as much time in an exam as he felt necessary. Every doc I've had since has been in a hospital-sponsored group practice running patients through as quickly as possible. The good ones have gone to the concierge model where you pay $1500-2500 a year just to be their patient. The whole thing stinks. I'm for Medicare for All.

  61. @DJ! My doctor’s group was recently purchased by a hospital. I know that a big part of the decision was the billing responsibility, since the group was employing legions of clerks to process paper for all the insurers. But I’ve also lived in France, where at the end of the consultation the doctor, not the receptionist or billing person, hands the patient the form and collects 23 euros, the entire cost of the consultation. If I were a citizen, I would have had a Vitale card, which would have streamlined the process even further. Why can we not have this in the US, and reduce this mindless and wasteful bureaucracy?

  62. My insurance plan, administered by United Healthcare, will not pay any facility fees. The medical group that I use is owned by Adventist Health, a large hospital corporation. Their family practice does not charge a facility fee but their pain management group does. They charged me an extra $50 for the previlege of waiting almost 1.5 hours in a stuffy examining room to see the dr. for a ten-minute exam. I wonder if Medicare for All could be worse than this? No wonder that doctors and large hospital groups are terrified of getting just a flat negotiated fee instead of their current bloated rates.

  63. I'm a family doctor. We are employees. We do not set or know the price for anything. We have the highest suicide rates of any white collar profession. We are all being squeezed here and I blame ADMINISTRATORS

  64. Only Medicare and Medicaid regulations support the billing of facility fees. Private or commercial payers are not required and should not be encouraged to pay them.

  65. And that cost is paid by the patient.

  66. I had a routine leuprolide shot at Memorial Sloan Kettering that my oncologist ordered. Because my doctor’s office is located in the hospital the shot cost $2,900. It was a generic drug, given by a nurse, and I didn’t even sit down for it so was in the office for about 2 minutes (after waiting for 1.5 hours for my scheduled appointment). I was expecting the bill to be ~$25 because I knew the drug was generic. What’s more shocking is that my doctor wanted me to get this shot every month for the next ten years! That is $350,000. You cannot trust that even the most routine, basic, or generic medical treatments will be reasonably priced and what’s worse is that they do not tell you the costs upfront. Doctors don’t know or won’t disclose and when I’ve called ahead the price quoted is always wrong. It ends up being double or triple sometimes. It’s hard to understand why the medical community gets away with this type of robbery.

  67. @KFC It's not hard to understand at all. Financial operators have taken over the entire health care industry (despite the many good people working in it), and are simply squeezing rents out of every imaginable rule and provision of the Medicare regulations.

  68. @KFC This is one of the more frustrating aspects! When you, as the patient, do your due diligence beforehand to ensure everything is appropriate and adequately covered and then something 'changes' and you end up with a gigantic bill. The whole system is an absolute disaster.

  69. @KFC New York State has a “No surprise medical fee” law. File a complaint with New York State. The fees should magically disappear.

  70. Physicians who practice in “supportive environment” are paid less by insurers than physicians who are responsible for their overhead costs.

  71. I’ve been fuming about this for years, ever since Mount Sinai in New York first starting charging an outrageous $250 facility fee for a visit to my internist, which is in addition to the physician’s fee and any charges for blood tests, etc...After two January visits to her office for an illness-when my deductible had just rolled over-i was outraged to see that these two visits (during which no equipment other than a blood pressure cuff was used) cost over $700! Mount Sinai has since extended this practice to other practice areas. They also reap higher fees for many in office tests and procedures because they charge you as if you received care in the hospital, which is a fiction. The billing practices for physicians whose practices are owned by hospitals is truly an example of how messed up our medical system is. Giant hospital systems-which claim to be “patient centered” blah blah blah—are really just taking the opportunity to increase their revenues without any commensurate change in the care they are providing. I believe the AMA issued a position paper against the practice of “ hospital-based practice “ billing for this very reason.

  72. @Lora S Americans need to vote. We need to demand a revised healthcare system so we're not in fear of an actual illness, in conjunction with outrageous bills.

  73. Do these Hospitals deduct the money or public funds raised by contributions and tax, for their building programs ?

  74. You are wrong. It is not the "facility fee" that explains the extra cost. The facility fee IS the extra cost. The explanation is the out of control greed of those in the medical and health insurance industries.

  75. As a private practice psychiatrist, I cannot charge a facility fee. Hospitals have bought out most medical practices so that they can add a facility fee and this has driven up the cost of medical care dramatically. Twenty years ago when I got out of residency training, the local hospital hired me and told me that they needed a psychiatrist, but that as soon as I built up my practice they wanted me to go out on my own because they were not in the business of hiring doctors. About 5 years later, everything changed and hospitals started hiring doctors and buying practices to make more money by changing the facility fee. To add insult to injury, they now tell their practitioners not to refer patients to outside specialists. Although this is a Stark Law violation, try and prove it.

  76. @dpjonesdo There is also quotas for how many specific procedures an employee physician is required or pressured to refer each month. Example: MRI's. You might not really need that $$ procedure - but you'll get it.

  77. I see the same situation here in my community. We independent physicians are becoming as scarce as hen’s teeth. I will not give up my autonomy as enticing as the extra $$$ may be.

  78. The facility fee smacked my husband and me after routine eye exams (what, we now have to pay for sitting in a chair?). And it wasn’t the only unexpected and undisclosed fee. The exams ended up costing double what we’d always paid before. I called other providers in the area for comparison, and at that time (2 years ago) none had ever heard of a facility fee. Moral of the story: Ask!

  79. @Ebosley this is why I go to Walmart for routine eye exams.

  80. The "facility fee" is a ludicrous example of unbundling - can you imagine any other area of professional services where the hourly rate or fee for the service does not include the rent on the service provider's office, the cost of their laptop, library, etc. I hate to agree with Donald Trump, and I have doubts about how effective it will be, but pushing for transparency in medical pricing as he did in his recent executive order, directing the US department of Health and Human services to write regulations mandate health services to present prices and fees in an easy-to-read, patient-friendly format and require out-of-pocket costs to be clearly disclosed upfront is really necessary. The reality is that one reason we buy health insurance is to have our expert, at the insurance company, negotiate the price of the healthcare we receive, cut through the deliberate non-transparency of hospital and medical pricing to get to a fair-ish price. Hospitals are in turn engaged in a game, where they massively inflate pricing in their chargemaster, so as to have a high starting point for negotiations, but also to massively increase the write-offs they can claim for unpaid bills (which deducations helps them declare no-profits as non-profits.) All of this gamesmanship is out of hand - most people, even lawyers and accountants cannot readily make sense of hospital bills - and routinely when challenged there turns out to be improper and duplicate charging. This needs a fix.

  81. @MacK Other businesses have started to charge for normal overhead. I recently interviewed a very expensive carpenter, who explained that in addition to the cost of the job I would have to pay 15% for his billing fees. I was stunned!

  82. A direct result of the methods by which medical care is paid for. This is dictated by CMS (government regulations for medicare and medicaid) and taken up by private insurers. It has led to many changes in healthcare, primarily driving medical practice out of the hands of doctors who used to own their own businesses individually or in small groups and into the hands of larger hospitals and "healthcare systems." As medicine becomes corporatized every nickel is squeezed out of the payors, and now with increased deductibles that payor is usually you. You can thank the government and the big companies (which own the government). We doctors don't like it either.

  83. @Victor Facility fees are NOT dictated by CMS. Yes, they allow them, and reimburse on a separate fee schedule (patient/patient's insurance carrier is liable for the rest) In fact CMS has lobbied against such fees, albeit unsuccessfully. Yes, it is a scam of sorts. So, Doc, will you support Medicare For All as one way to eliminate this scam?

  84. @LesISmore The fee itself is not dictated by CMS, but the way doctor visits, procedures, etc are paid for is. And that is a three part charge - one for physician service, one for facility charge, and one for malpractice insurance. It should surprise no one when smart business people look at this and figure out how to game the system. As to your second question, yes by all means I would be very happy to have M4A. But unless we can figure out how to get the government to serve the interests of the public rather than that of big money - which it does now, you and I might not like the system which evolves.

  85. @Victor As a doc myself I am all for medicare for all or even better- make healthcare a public service like police, fire etc. Firemen dont have to pay for fire training schools, govt does. Same way please train all the doctors and then make then public service employee, pay salary and pension and thats it.

  86. My last two insurance companies didn't pay for facility fees. Those fees were 100% payable by the patient. Worse, the doctors were directed to do some of their care in the hospital building just so they could collect this extra money - there was no benefit to the patients. Even worse, there is no law about how much they can charge in facility fees. Naturally, people don't go to the doctor prepared to pay hundreds of dollars extra. They were prepared - they wanted your credit card at the desk.

  87. Live in Scandinavia. My own share for any medical treatment is abt $ 25, even if I end up in hospital for a year. Its covered over everybody’s tax bill, were those who earn the most, pay the most. Even Scandinavian billionaires would not dream of changing that, its just common sense.

  88. @Ole Olsen Good point. We talk of cost to we consumers but never talk of controlling them,. Medical care is not like buying a TV no shopping at round when you have a heart attack or accident, you are at the mercy of the provider and many many thousands of dollars may be added to your bill while you are unconcous.

  89. @Ole Olsen "...where those who earn the most, pay the most." Disingenuous to choose not to add: "And where those who earn the least still pay >60%."

  90. @sf Not in Norway. They are presently living on their North Sea oil money. But even in Sweden without that oil advantage middle class tax rates on income, including social benefit taxes, sre roughly the same as those in NYC.

  91. Hospitals, even "non profit" are often the most profitable businesses around. For profit hospitals are more profitable than "non profit" due to "revenue management", not due to efficiency or costs. However, health care should be not for profit at all. Profit is a perverse incentive in illness and infirmity and "health" care. This facility fee is just another way Americans are being fleeced by the "health" care industry.

  92. Elizabeth Warren preaches Medicare for all is the answer for escalating Medical costs. She's going to do that by getting rid of Insurance Companies and greedy drug Companies, but nowhere have I heard her call for reigning in the practices of Providers that are discussed in this article. Either she doesn't know or care about the source of Medical Care inflation. Soak the "rich" is her only solution for all the massive freebies she espousals. Right now, however, it is only the "greedy" Insurance Companies that reigns in the cost of Health Care. Universal Health Care only works with controls, like where, what and from whom one gets their care. No it won't be free and her proposals will lead to Medical Care Hyperinflation until it consumes most of the budget and everyone will pay. What might work is creation of a National Health service, where MDs are salaried and care is provided in NHS facilities. Role model, the VA system. That is where one must get their care. Of course, a private system will arise, made up of many large provider groups, who will opt-out of the NHS system and require Private Insurance (or Cash) to access. Role model, every country that has, so-called, Socialized Medicine.

  93. @bahcom "nowhere have I heard her call for reigning in the practices of Providers that are discussed in this article" Obviously you didn't read Kugman's review of Warren's plan where he indicates that her plan would " provide significant savings in overall medical costs ... Some of these would come from bargaining down prices, especially on drugs. Others would come from a reduction in administrative costs."

  94. @Jim G oI read the article you cite. It is based on wishful thinking as are Warren's proposal.

  95. I recently installed a collision avoidance device on a doctor’s airplane. The doctor pulled up in a Audi sports car, and told me he recently paid $400,000 for his fixed gear, single engine airplane. He cried poverty numerous times during the 10 minutes I spent with him.

  96. @Paulie $400K: that's inexpensive for an aircraft, I think.

  97. @Paulie At least a couple decades ago (maybe three), the Times printed an article titled, as I recall, "Earning $650,000 and poor". Of course the economics are skewed. The point was that just because you're earning a bunch of money doesnt mean you're not spending it on private school for the kids, a house in the Hamptons, vacations in Gstaad and other exotic destinations. So while the doc you did the work for cried poverty, he's more likely overspent than actually poor.

  98. @Paulie Just wait until you get called by an insurance company or "non-profit" hospital administrator- expect him to roll up in a Rolls Royce and Gulfstream private jet. In the end that is where most of the healthcare dollars we are all paying end up in this perverse system.

  99. “One option might be to stay with your doctor for long-term, serious health issues, but to use lower-cost venues, such as walk-in clinics, for minor problems.” And now we see how the consolidation of hospitals and medical practices disrupts the patient-provider relationship...in addition to leading to higher costs. This is quite the scheme and maybe is a big part of the reason health costs rise faster than inflation?

  100. In my area the hospitals charge a hospital fee in addition to doctors ‘ fee; I have great insurance with the same dollar value co-pay regardless of the procedure. Let’s face it, hospitals have to exist and pay staff, porters, cleaning staff and healthcare support staff; someone has to pay or the hospitals will close. Yes, in big cities with hospitals associated with medical schools and colleges that have endowments maybe thee doth protest too much but I only use hospital supported clinics by choice and as responsible adults, do realize that cost must be paid to support the staff provided by the hospitals. I was an RN in NYC for over 40 years and hospital staff are very cost conscious except that the waste and abuse is at the very top with high executive pay above what should be required to run the place: ABUSE by the higher echelons. Many rural hospitals have closed due to cost, there is a lot of discomfort in rural area because medical care is scarce.

  101. @JRS This apply to small rural and smaller hospitals but last years the big ones made billions in profits as did most insurers and of course the drug guys. Profits in most of medicine are way way high. A knee operation in USA may be $50,000 or more, in France $5,000. Drugs (same ones) in Europe 6X the cost in USA.

  102. I support using the least expensive way to provide healthcare; that’s why I chose to go to hospital clinics, wait with the common folks.

  103. @JRS But the hospitals charge you $20 for a generic aspirin!

  104. This is market failure. In what other realm of economics are prices not revealed in advance, giving the consumer the opportunity to decide whether or not to incur the cost?

  105. @Mimi It is far worse than that. I live in a semi-rural area with only one hospital managed but not owned by the Catholic Church for profit. Not only are the fees very steep but no doctor who does vasectomies or tubal ligations is allowed hospital privileges.

  106. When systems everyone depends on function like monopolies, bad things happen. Even police do not have a monopoly- there are local, county, state and federal law enforcement with jurisdiction over the same real estate. The problem with a purely public system is providers soaking the collectively wealthy taxpayers instead of often-poor individual patients. The former seems better in the short term, but remember that public systems are very hard to change. Vulnerabilities can persist for a long time and be exploited for astronomical sums. Individuals and insurance companies are more flexible and can eventually benefit from technology, close loopholes and game the system back. It is a pain for all involved, but it might beat the alternative, and the savings might be enormous in the long run.

  107. @Alan, What evidence do you have that healthcare financing in the US is better than the alternative? Is is our comparatively short lifespan? You like medical bankruptcy? Oh I know, you like that our terrible system costs twice as much as any other developed country.

  108. Our medical costs are due to the crazy, uncontrolled pricing. It is abusines that can create its own costs a with no controls. They often have a captive audience who have no choices, no way to understand ahead of time the costs. The costs can be added on as they go, and any cost is acceptable. A $3 bandage, a $4 aspirin etc. A single payer system could bring this under control and make us all free of these rip offs.

  109. While the idea of a facility fee makes sense, I wish very much that hospitals were much better designed for economics. Why does the entrance way to a new hospital have to be soaring several stories in height? Why must the walls contain so much glass? Etc., etc., etc. Why can't the buildings be much more functional and economical? Enough with the fancy, artistic architecture!

  110. Some overdone hospital lobbies are provided by charities associated with the hospital. Many hospitals seem to have active social/charitable arms. Still seems like a waste of money.

  111. @KittyKitty7555 The reception area of the oncology center at my local hospital has a sign up thanking a pharmaceutical company for redecoration.

  112. Ole Olsen, I would not feel comfortable using any hospital service, rent free for a year. We have over 330 million people to provide with healthcare and many of our wealthy have not invested in this country; they hide their money in Bermuda, Camen Islands or even Ireland or maybe Scandinavia. Some countries win, others lose. Go figure.

  113. IMHO, a Facility Fee is a way to steal from the patient. The cost of the physician's time, the lab fee and all other services already have a built in fee for "Overhead." To tack another fee is outrageous. I'm on Medicare. The fees approved by Medicare are sufficient for the the hospital to make a profit even though most hospitals are "Non-profit."

  114. @Jeff: The hospitals may be "non-profit" but their executives sure aren't! Those C-suite execs are raking it in hand over fist. And then they claim there's no money to hire enough nurses...

  115. Seek care in a Federally Qualified Health Center - there is no facility fee, they make their service available to everyone with a sliding fee scale for low-income families, providers are not pressured to refer me to specialists and hospitals in an effort to sustain hospital infrastructure and hospital executive compensation packages. Also, unlike hospital owned practices, these health centers are required to report their quality of care outcomes annually, which is then published by the Health Resources Services Administration - so you can know if you can expect good care.

  116. @TJB Wow, thanks. It's rare to actually learn something helpful amongst all the ranting.

  117. The facility fee is just another ripoff by the hospital. Since the doctor is no longer paying rent to a landlord of mortgage interest to a bank, he should be paying the rent (facility fee) himself to the hospital. As it now stands, when a doctor chooses to sell his practice to a hospital, the doctor increases his profit by the lack of rent and the hospital increases it's profit by the facility fee. Akin to a 3 card monty game.

  118. @impegleg: You don't seem to understand that the doctors often have NO CHOICE about this - they are usually forced to become hospital employees or else they will lose their admitting and surgical privileges. This is about keeping doctors under the hospital execs' thumb, and keeping all available $$ in-house at the hospital. The doctor is paid a salary - and most of the good doctors I know who've been forced into being a hospital employee are planning to get out as fast as they can, b/c it's utterly changed the practice of medicine. To the hospitals, most of us are now just an account number, and a set of metrics. We are a 'target' to be 'hit.'

  119. In the Netherlands i pay 108 euro per month. It includes everything. No hidden fees. Includes meds;hospitals etc. However they tightly control expenses. It is not single payer either. The insurance companies are usually non-profit. It was one reason to move back to Europe.

  120. Write a letter to the CEO of the hospital, send it certified, and mention the word malfeasance. A prompt response will appear in your mail box. Make sure you first consult someone who has worked in the medical field, Always save all medical bills for evidence of fraudulent charges.

  121. This doesn't even get into the fact that it is the insurance company rather than your doctor or therapist that may control the duration of treatment. And costs are indecipherable. I attempted to find out the actual cost of physical therapy I was getting and got a good look at the receptionist's chart showing all the different insurance companies "allowing" different numbers of visits for my issue and paying the provider wildly different amounts for the same treatments. "But what is the Actual Cost that you charge?" I ask, only to find out that there was not really any such thing. Everything was flexible, based on insurance company negotiations. The person next to me in the therapy room doing the exact same things might be paying twice as much, or half as much until the deductible is met. My attempt to be a good responsible consumer was useless.

  122. @Diane Helle I share your frustration. I've tried to find the cost for certain services and/or procedures. The medical providers can't tell you in advance: it depends on the codes that the MD/business office enters and the negotiated rate with your insurance company. The prices vary widely. What I've noticed is that billing is "unbundling" each episode of care: Office visit; draw blood fee; lab fee for lipid panel; lab fee for CBC; lab fee for blood chemistry panel; facility fee, etc. etc. This drives up your costs, and results in you paying your "lab service" co-pay multiple times, once for each component test. That did not happen in the past.

  123. @Diane Helle: "My attempt to be a good responsible consumer was useless." Which is EXACTLY how the system is designed. BTW, remember when drug stores were supposed to prominently display a list of drug prices where all could read it? Have you seen any of these lately? Me neither.

  124. We had to go to the emergency room for a concussion and we were billed a facility fee and a doctors fee. What was really confusing was we were handed a document, while we were in the emergency room (after we had gone through a metal detector and filled out check-in paperwork), that said we would not be charged more than X amount. Apparently that was only for the facility fee, because we got charged twice that in the end. I am about to graduate with a degree in Health and Exercise science and I have never had less faith in the healthcare industry. I am amazed everything works as well as it does, to be honest.

  125. My son had a severe allergy attack. The hospital bill was $35,000 for 1.5 day stay. When the bill arrived, it was a single sheet of paper stating $35,000 due. No description of the fees or services rendered for the cost of treatment. When the bill was later argued, the final tab was $14,000. This is why medical care is for the well insured or wealthy only. Something needs to be done with the rampant overcharging and pilfering of Americans who are at their mercy. Hospitals (and the corporations who own those hospitals) need to held accountable for fraud. If the final bill was $14,000, then the original bill at $35,000 was an attempt to flees their patients. How many pour souls have had their wages garnished for the full price of services rendered, when the hospital was fully aware the charges were over billed? That's criminal in my book. Until CEO's start seeing jail time, their only concern will be the "bottom line profit".

  126. There is yet another way that Medical providers increase their incomes, that is to get a piece, if not all of the Facility fee. Outpatient imaging, surgery, infusion, dialysis are examples of that. The MD owns the facilities that they refer patients to. DR orders the surgery, directs the pt to his surgery center, where he gets his fee for the Surgery he ordered, extracts a facility fee if he can and gets the profits from the facility. That is a Triple Dipper. As a retired Nephrologist, I know that gimmick well. I was there when the baby was born.

  127. Diet and exercise are great ways to avoid these fees.

  128. @Len319 Glad you never had an illness that has nothing to do with diet and exercise. So i guess you don't go for routine screenings either? They recommend that women have mammograms every year or so. Can diet and exercise avoid those? Your kid ever get hit by a car or break a bone? Diet or exercise would cure those?

  129. @Len319 My daughter fell on the playground and dislocated her elbow last week. We're paying $7000 (plus $1000 a month in health insurance) for that accident. Diet and exercise would not have avoided the problem. We've got $20,000 in health care costs this year. I make $62,000.

  130. Oh Len...all I can say is wait til it happens to you...

  131. The doctors allowable charge in a hospital based facility is lower too.

  132. Legitimate theaters have been surcharging "facilities fees," sometimes called "theater restoration fees," for years (presumably on the not entirely unreasonable premise that, if you're already paying upwards of $200 to see "Hamilton," what's another buck or two?); a trick they learned back in the 1970s when ordering tickets by credit card became a regular thing and someone thought up the phrase "service charge." And it's only a matter of time before restaurants charge extra for table seating, and "rent" on the dishes and silverware. And what may finish off the malls for good is when stores start charging admission. That's why we still need paper receipts, gang, and we need to be unlazy enough to look them over for questionable items. Each increasingly familiar instance of price gouging is another nail in the coffin of the American middle class.

  133. These tactics are what makes many people including me more supportive if a nationalized healthcare system. If these hospitals, pharmaceuticals, doctors, and insurance would not try to make obscene profits that abuses everyday people, candidates like Warren or Sanders wouldn’t be so popular. They need to realize their collective greed is going to be the downfall of their long term profits.

  134. @Rojo: The hospitals all have very effective & well-paid lobbyists who ensure that this collective greed is not just continued, but enshrined! They have the lawmakers in their pockets.

  135. The facility fee I was charged at an outpatient surgical clinic, for a routine screening colonoscopy, was over $11,000 in 2018. The owner of this facility is one of the 5 major medical systems in the Milwaukee, WI area. My long time PCP practices there and he was dumbfounded by that charge. What is happening is the medical systems have excess cash at the end of the year and want to use that up, so are building new clinics, freestanding surgical centers and hospitals that are unnecessary, underutilized and drive up costs unnecessarily.

  136. Lucky Americans and their low taxes.

  137. One can only avoid these costs in the future by voting for Democrats. The Republicans have done nothing, are doing nothing, and will do nothing to bring this country into the ranks of the civilized countries, where people expect and receive services for their taxes and even poor humans have value. Our non-system is as Byzantine as it gets as anyone with experience of a system that works will tell you. It's such a shame that so many voters continue to be manipulated and fooled by people who only care about them as far as they can use them.

  138. Glad I live in the land of the free (healthcare), Canada! With an election coming up, you guys should be pushing your Reps for socialized medicine - it really is the better way to go.

  139. I had an asthma attack and went to the ER at the University of Pennsylvania hospital. I received a bill for $800, which (sadly), I thought was a good deal given my horrible insurance. Come to find out that was just the facility fee! A second bill for actual services rendered came weeks later and it was for her $2000. Healthcare in this country is horrible and I have what many would consider “good insurance.” I can’t imagine the suffering that others have to go through.

  140. @NA this is so frightening to me. I am hospitalized a few times a year here in Australia with Asthma flare ups. It costs me nothing. I know we pay higher tax for the privilege but I also know how much panic an attack causes and would hate to have to think about how much it was going to cost while fighting to breath. The costs in the US are insane to me!

  141. @Kb Ditto for Canada. The thought of spending time fighting to determine fees before and after treatment is very daunting.

  142. @NA When you divide the E.R. overhead costs by the number of people who visit that E.R., I doubt the answer is $800 per patient ... Somebody is skimming off the excess money that is generated by this excessive fee.

  143. Your doctor visit is more expensive because American doctors and hospitals are, on the whole, rather greedy. The "facility fee" is the medical equivalent of Miami Beach's "resort fee" -- you get to pay for the same thing twice.

  144. I'm a Canadian and have never heard of or paid a "facility fee". Think about it America.

  145. Soon to be followed by a "not punched in the face" fee and "not kicked in the shins" fee. I am US-born citizen but I wonder what fee would push me to move to Canada or Europe or Asia.

  146. I am becoming radicalized. Outrage will do that. If you have an outpatient procedure - ambulatory surgery - paying for the OR is reasonable. If you have a gynecology annual exam in an office, it is not. That’s rent taking, literally. I don’t pay my mechanic for the cost of his lift. I pay him a service fee for the job. I don’t pay $59.99 for a kitchen gadget, plus $25 for the cost of store renovations. If a medical practice cannot cover operating costs, that is a failure of insurance rates and unfounded mandates, poor financial management and profiteering. I don’t really think Medicare for All is viable as there are too many who can’t see the benefit of removing profiteers, third party administrators, and your boss from medical decision making. Charge those folks an out of pocket fee for using the elevator and bathroom and see if that changes.

  147. @Cathy Medicare allows the charging of a facility fee. In fact, if your physician was in private practice and a hospital bought his practice, the hospital got to charge Medicare a higher charge because the practice was now part of a hospital system. And a facility fee. The reason Medicare for All is a heavy lift is because intelligent, educated voters are well aware that the big medicine cronies are not giving up any of their largesse. Instead they will examine the new regulations and figure out how to increase their profits. When you take your car in for repairs or buy a kitchen gadget, you are dealing in a free market. There are times you overpay for inferior goods or services, but are free to complain and get a refund or tell your friends and communicate. [Same if you get superior goods and services for a low price.] There is very little visibility to quality in medical goods and services. If you see and advertisement on television, it is very difficult to figure out if a drug or service offers value. It is virtually impossible to determine if your physician lost his license in another state, if the hospital you are having a joint replacement in has a high complications rate or if the nursing home your grandmother is in has ever had a satisfactory inspection. And it is virtually impossible to find out how much anything costs. American medical care is about as far from capitalism as possible. The government has made a mess.

  148. Quick answer: an inefficient, inhuman private healthcare system. Can’t wait til the day I won’t have to scrutinize a bill or fight an insurance company to cover it.

  149. @Jason Snyder Mexico is looking better and better for healthcare treatments. Just fly your own doctor down and use their facilities.

  150. @Jason Snyder move to Canada or Scandinavia. Problem solved. Don't hold much hope for our country joining the ranks of civilized nations. More than ever, the riches of the rich matter more to policy makers than the needs of the poor, AND the people who have contracted for so-called medical insurance.

  151. @Jason Snyder Don't hold your breath.

  152. It's getting ridiculous. I thought about taking some college courses only to discover that the local college is now charging 35 dollars per credit hour as a "building fee." That adds $105 to each class in addition to tuition and other fees. When I went to college in the 1990's, there was no such thing as "building fees." Tuition was supposed to cover the cost of sitting in a classroom. Now hospitals are charging fees to use their equipment when it used to be part of regular care? It's just a way of gouging the consumer, just like colleges charging students extra to sit at a desk in a classroom. Will stores start charging us a facility fee for shopping in their building and using their lights and restrooms?

  153. It's called "Overhead". "Overhead" eats into "Profit". Doctors and hospitals aren't alone in doing this. Bullet fees are levied in Iran and China, billed to the families of executed prisoners. Always ask your doctor, "Does my insurance cover this?" Always.

  154. @Dick Ellingson Just don't expect them to know the correct answer. One of friends has been told several times "Medicare won't cover this" when it just did a few months ago, and will this time also.

  155. And they will answer, “I don’t know. You would have to check with your insurance company.” And good luck getting a straight answer out of them...

  156. @Dick Ellingson Your insurance covers it except for the co-pay. After your deductible has been satisfied.

  157. As the auto retail industry gets more transparent and consumer friendly, the healthcare industry gets slimier, more opaque, and sinister

  158. We all support this system by paying too much for health insurance. Can we fault doctors and hospitals for filling their coffers when the spigot is gushing money? Meanwhile, most of us are too afraid to go without insurance. We lack the courage to face possible injury, possible death, so we allow our own exploitation to continue.

  159. @Frank M Gee, Obamacare made it illegal for insurers to get more than 15-20% for profit and overhead? What that did in effect was make insurers cost-plus contractors. The hospitals jumped in and raised their prices at 3.3 time the rate of inflation and the drug companies raised their prices at 2.4 times the rate of inflation. The insurers added up the likely costs for the next year, added 15% for group policies and 20% for individual policies, and passed on the cost of overbillings to consumers and taxpayers. How did it work out with Medicaid providing free opioids to able bodied childless adults? Government policy, with respect to both no co-pay for the poor and refusal to hold Mexico and China responsible for illegal drug trafficking, made things worse and the politicians are now suing the drug manufacturers.

  160. @Frank M It sounds attractive to go without insurance intentionally, assuming you can afford the costs and risks. But there is one HUGE problem with being uninsured: Hospitals, doctors, drug companies, medical practices, labs, etc. have list prices that are VASTLY higher than the insurance-negotiated prices, and you to pay those extraordinarily exorbitant prices if you don’t have insurance. If individuals could pay the same prices as the insurance companies then going uninsured, or uninsured except for catastrophic illnesses, might indeed be a wise choice for some. But this huge disparity in prices severely disrupts that logic. The problem is caused by the combination of insurance companies, hospitals, large practices, drug companies, pharmacy benefits managers, etc. Part of the kabuki dance is pretending to give the insurance companies a good deal. If all involved had to publish actual prices and stick to them for everyone, many problems would disappear. As others have said, like a grocery store or restaurant.

  161. @Alexander: you are right of course. Higher prices charged to the uninsured are another lever to force people into an oppressive system. I’m fed up with it. At least for the young and healthy, the moral decision increasingly looks like refusing to participate and taking our chances.

  162. At least the questioner could identify the facility fee on the bill. The massive, greedy health system that occupies our region sends out invoices without itemized charges. You just get a piece of paper with a bottom-line number that you’re expected to pay. When you ask for itemized charges, an excessive number of days go by before you receive a printout of bizarre items that mean little to the lay person and bear no resemblance to the figures on your insurance claims. Another tactic of this institution has been to gobble up small specialist practices and form them into “institutes,” thereby tripling the price of a visit to your orthopedist or urologist. Much of the extra profit goes not to improved healthcare, but to exorbitant executive compensation and to expensive marketing, branding and advertising, including major sponsorships of area rock concerts. Please do not let Elizabeth Warren’s aspirational ideas on Medicare for all prevent you from voting for her. When it comes to fighting the medical-industrial complex, she may be all that we have.

  163. @LIChef The cost of Medicare inflated after Obamacare "improved" it. What would make you believe that if it became universal costs would decline? The elite executives running the system are not going to take pay cuts even though they are superior only in their own minds.

  164. @ebmem If we had government-run healthcare, like virtually every other country in the world, no insurance executive would be making a salary + bonus + stock options that adds up into the millions per person. There's your savings, right there.

  165. rigged markets can be very confusing. perhaps the lack of a free market in healthcare suggests it should be nationalized.

  166. @bill zorn Better yet, how about if we get price and quality transparency and become a free market? There is no evidence that socialism has ever beaten capitalism in providing the highest quality at the lowest price. You cannot identify a single example.

  167. @ebmem You recommend disbanding the fire department and having everyone hire their own firefighters on the open market. You recommend disbanding the police and hiring patrolmen privately when you need. Medical care is not a free market because when you are sick, no one knows what you will need and how much of it you will need, so no amount of transparency will allow you to price your purchase. In addition, you are often too sick to go looking around for the anesthesiologist who is offering 20% off that day. Finally, because physicians are credentialed to practice only in certain institutions and settings, you can not choose anyone - the practitioner needs to have the credentials to do what you want, where you want, when you want. So the purchase is not for one service, but for a system with various strengths and weaknesses, and the cost will depend on what you actually turn out to require. Finally, if the paramedics take you somewhere in shock, your purchase is already made.

  168. If you have to go to the doctor, hire a lawyer and forensic accountant to represent you when you walk into the door. Have the lawyer interrogate everyone you come into contact with as if taking a deposition. Have the accountant demand that he/she can look at the books and see what's going on. Even after you pay for the accountant and lawyer, you probably will come out ahead. Medicine has become the greatest- separate people from their money- scam that has ever existed. I don't go to the doctor. If something goes wrong, I try to figure it out and give it time to heal. If it gets better and goes away, I don't worry about it. For example, recently I had developed some severe bloating and discomfort in my stomach. Felt like I swallowed a bowling ball. Turns out, I had become gluten intolerant. Cut out the gluten and I'm fine. Probably saved myself $10,000. If it had gotten worse or not gone away, I would have gone. People should use social networking to list facilities and practitioners who charge these outrageous fees. Out them. Yelp them. Let everyone know and boycott those places. Hit them where it hurts, the pocketbook. Stuff like this makes me want to socialize medicine. I'd like to see a single payer option where the enrollees go to government clinics funded by tax dollars. Not for profit is a joke because operating expenses come out before profit and those expenses go into people's pockets.

  169. Why does a hospital have to charge a "facility fee" but not say, Home Depot or your local grocery store? The answer is that they can, it increases their profits, and customers cannot do anything about it. Imagine if other businesses could behave like health care. You go to the grocery store and no prices are visible anywhere. Or if they are, they "estimates". A month later, you get a bill (which is doubled by a "facility fee") which you cannot understand or dispute, and must pay. If one grocery store did this, they'd go out of business. If they all did it, they would get richer and richer.

  170. Commercialisation and consumer driven medical practice is another profit driven industry where medical decisions are influenced by insurence companies, hospitals and incentives physicians receive . You may visit your physician for a simple problem like an uncomplicated rash or a trivial trauma, the physician may barely touch you for the problem but can document complete exam with the help of prepopulated format in the EHR which is essential for billing , sort of upcoding to get more reimbursements. It is a shame Art of healing has degenerated to art of greedy profit making. Culprits are people without medical insurence and honest physicians who want to practice within the boundary of medical ethics

  171. Did not mean to say culprits. Supposed to be victims.

  172. Well, this explains why the so-called free Medicare wellness exam ended up costing me over $200 out of pocket, when the cost of the shots/lab was only $24.

  173. @Jrb This fee was added under the Obamacare law to compensate for the fact that preventative care had to be provided free of co-pay. And, obviously, it was extended to non-preventative care once created. Then there was the massive expansion of hospital systems to buy up all of the local practices. The hospitals wanted additional revenue to compensate for the capital investment. O'Care was designed to make money for hospitals. Instead of reducing a families cost by reducing cost shifting, hospitals increased there prices at 3.3 times the rate of inflation. Nice work if you can get it.

  174. No, this would be $0 out of pocket UNLESS you and the doctor addressed additional issues during the annual preventive visit, such as diabetes, high blood pressure,medication changes, etc. Those services are billable in addition to the Medicare wellness exam even if done at the same visit. They take more time and are not preventive in nature. You should have been informed of this policy in advance. Many patients see the wellness visit as a “freebee” onto to which they can tick on a year’s worth of concerns. It doesn’t work like that. Once a year preventive visit is free, medical management visits are subject to co-pays and deductibles.

  175. @Rob Merrill. What I have learned is that you can not ask any questions during your well visit. If you ask a question, it is not longer a well visit. Why would a person go to the doctor and not ask any questions? It doesn't make sense.

  176. Transparency is what is needed here. Hidden costs presented after the procedure should be made illegal. A restaurant provides me a menu so that I can select on what I want to dine. With the description of the food is the cost. At least I am made aware at the time of ordering what it will cost. Yes, I realize that I am paying the bill here and not some insurance company but I know the cost. Why aren't the costs, covered and uncovered made clear well prior to the appointment? I realize there has to be flexibility to support the medical provider a window to perform procedures beyond what was initially expected to be completed but there are many costs " facility fee" that can and should be detailed well prior to the actual visit. These costs are not transparent and should be.

  177. I am a doctor in the Netherlands. Facility fees don't exist here. Can anybody help me to tap in this lucrative system? Will telemedicine reshape the system? I am ready for this.

  178. @Guido De Cock Telemedicine will mean you pay the same, while overhead costs will be less. It means the doc doesn't see you in person--can't touch your ankles to see if you are retaining fluid and in heart failure. Can't listen to your lungs and heart with a stethoscope, can't look into your ears, can't smell a peculiar odor, e.g. one that could lead to a diagnosis of pseudomonas infection, lung abscess, or cancer.

  179. Try asking your doctor how much your visit will cost. Chances are they have no idea (and many don't seem to care). But our financial security is clearly related to physical health. Why don't doctors act as if it matters? I will not go to a doctor whose office charges hidden fees, or who personally seems not to care about my financial needs.

  180. “Imagine if other businesses could behave like healthcare”? As a physician I say bring it on! “Other businesses” have the ability to set charges based on overhead costs and quality of service. Not so in healthcare where both private insurance and Medicare/Medicaid dictate charges. When your overhead is subject to normal forces of capitalism (i.e. rent, wages, supplies) but collections are essentially fixed, I promise you it is more than a distraction in the daily struggle to practice high quality medicine while also running a small business.

  181. @Lawrence Fiedler While I sympathize with running a business aspect, I have a problem with comparing a medical practice with, say Walmart. First, nobody forces me to shop at Walmart unless it is the only store in town, while my insurance, forced on me by my employer, does tell me where I must go for healthcare. There is very little patients can do in selecting where to get services. Even then, it is all very confusing and very exhausting, much less when one is sick already. The stress of seeking care might kills us all as a result.

  182. Cry me a river! You can always opt out of insurance services of you don't like the prices. So, don't pretend you have no choice in pricing. The truth is, nobody can afford your service without insurance. Your business is overpriced. And yes, in the other businesses I know price before hand, but to get prices from doctors is impossible.

  183. No one is objecting to doctors making money or being able to pay their overhead costs. It’s the surprise nature of medical billing that is driving all of us batty. If you have to make up charges to tack on to customers’ bills in order to make money, you are not running a small business, you are running a scam.

  184. Facility fees also pay for services that patients are not billed for, like social work, nutrition, phlebotomy, and clinical pharmacy consultations. Insurance companies understandably want to keep their padded margins fat; but that shouldn’t come at the expense of added services for patients.

  185. @alex Read the article again. Insurance companies do not charge facility fees, hospitals do.

  186. If you don’t want to scammed by the facility fee stay away from medical practices that are part of a hospital system.

  187. @Sasan Yasharpour Good luck with that. In our market, all of the practices are owned by hospital systems. I don't think there's an independent practice left.

  188. My child used to see a doctor in a teaching hospital in Boston and the faculty fee was high. He had appointments available in a suburban office a few days a month and we moved all of our visits there. No facility fee, no traffic and no parking fees.

  189. In at 11am, out by 7pm, hip replacement surgery which took about an hour with no complications. Cost was $67,000. How is anyone going to afford getting medical treatment without health insurance? Donald Trump and the Republicans couldn't care less.

  190. @JM When did this start? Only since January 2017?

  191. @JM But, if you have Medicare, the providers probably get less than 10K for the surgery. I supposed it's for tax purposes, but hospitals, doctors, etc. all bill far more tan they receive from the insurance company of Medicare. For example, my last Mammogram was billed at over 1000 dollars, but less than 100 was paid by Medicare. I'm not responsible for more than what Medicare pays, so I can only assume that the remainder is used as a tax loss. As a former nurse, I was involved in billing for supplies used on Medicare recipients. The same thing went on then.

  192. @JM Hospital charges are a grossly inflated sum which Medicare, Medicaid, and insurance companies ignore, paying instead the allowed or contracted amount. The only people who get stuck for the full amount are those who make just enough to be excluded from Medicaid, while unable to afford private insurance. Their only option is to declare bankruptcy with all the adversity that entails. Is it any wonder that foreigners think we are either stupid or insane? Trump and the Republicans have promised us a really, really stupendous alternative plan which they decline to divulge. Bring on Elizabeth Warren.

  193. The advice given in the article is terrible and points to the ways the system is broken. Doctors' practices are being gobbled up by hospitals. Your options for independent practices are decreasing. And walk in clinics are fine for strep or conjunctivitis but useless for ongoing issues. The advice to consider based on finances is necessary.... but points to how our insurance system is tiering healthcare. Meanwhile deductibles and coinsurance are rising so I have to pay more and more of these facility fees for visits. One of my kids' specialists is part of Johns Hopkins, which has outrageous charges (remarkably, Blue Cross pays almost all of the charged fee). Because she's a specialist and we had to travel over an hour to see her in the first place, it's not easy for me to just switch.

  194. "The decision should be based on one's finances..." No, it should not. This is what is wrong with doctors and medicine today. Just this past week my PPO insurance company redirected me to a surgeon who even they admitted "rarely" does the procedure I need because he is in-network. It's a very ugly thing.

  195. A fee for maintaining the premises. This sounds like another line item scheme added to extract more $$ from patients. In ANY other business your cost of goods sold INCLUDES maintaining your premises. The American medical system is corrupt, opaque, and the costliest in the world. Get politicians and lobbyists out of the medical business and let the free market determine which facilities are providing the best outcomes for their patients. Until Americans stand up and demand a fully transparent cost for service rendered, aka menu, in plain English there will be more of these creative money grabbing scenarios perpetrated upon us.

  196. glad I'm on Medicare advantage. No big surprises

  197. @ed Except when you have to change doctors because they no longer consider last year's doctor in-network. I've seen people go through that.

  198. @ed I'm on Medicare Advantage, and I just got an extra $1300 facilities fee from the hospital almost a year later. Watch out.

  199. Costs must be capped in all sectors of healthcare, including insurance, and especially pharmacy. It’s absurd and untenable, and people are getting hurt. I can’t believe anyone even goes to the doctor anymore unless it’s life or death.

  200. about 5 years ago i switched from my primary care doctor(due to what thought was his incompetence) who was an internist, to a PA in the same medical group and practice. His charges were about $125 per visit if i remember correctly. That same year the local hospital bought out the medical group. The PA charged me a whopping $275 per visit afterwards!! Go figure that. i did. it was due to the hospital buyout and their desire not only to recoup their money but to increase their profits even though they are supposedly non profit. i ended up dumping my PA who was even more clueless and incompetent. When I lived in Eugene, Oregon some 10 years ago, the local supposedly non-profit hospital, Peace Health, built a brand spanking new hospital costing over $300 million . A non profit building such a hospital? Where did they suddenly find all of that money? Our health care system isn't health care. It's a money grab. HCINO. Health Care in Name Only

  201. Non profit and/or not for profit has nothing to do with what they charge for services. It is a license to have extra agent facilities and high or overpaid staff and doctors. Why be conservative with costs when you have to spend it all anyway. As a while the US needs to do away with All of the various ways to not pay taxes starting with all 501c3 companies.

  202. This is nothing more than a "regional sports fee" tacked on to a cable or satellite bill. It's a fabricated fee and shouldn't be allowed to be passed on to the consumer/patient. How outrageous is it that hospitals feel they can make up fees and expect patients to pay them? They seem to feel patients are hostages to their demands. Not so. We have the choice to fight back and make them remove these monetary gouges.

  203. (Ahem.) Universal Health Care.

  204. This is not medicine, this is just another scam. Another way to get your money while pretending that these charges are legitimate. 

  205. Seriously? The medical establishment is cooking up more ways to make health care more expensive in the US? What don't they get? Ask your doctor to meet you at your car in the parking lot. In what other countries do doctors charge "facility fees"? Is this like the "resort fee" that Waikiki Hotels started charging several years back? (Seriously, Waikiki, have you measured the size of your swimming pool? Now compare your pool with the one at the Shangri-La Ocean Grove Road in Singapore. With the "Swimming Pool Rule" I rest my case. With all untreated drug addicted alcoholic homeless people living on the street right in front of your hotel, Waikiki is the last place I would label a "resort", more like an upmarket urban jungle with a scenic beach.) What if the Dry Cleaner starts adding "Resort Fees"? I digress, I mean "facilities fees". Ask your doctor if higher fees are right for you. They're definately not right for your doctor, and they or their employer need to start posting their prices upfront out front. If the coder's list is way too long, a pdf version on the internet will do. Also post the deals and side deals you cook up with the insurance companies. Rubber pricing in the medical industry depends on their cozy relationship with the Insurance Industry to keep it afloat. What you pay depends on who you are. Medicare for all means truth in pricing, no third party profiting off your misfortune.

  206. The sad thing is that the “facility fee” does not get included in inflation, even though our costs have gone up. Yet, it is included in GDP, even though nothing new has been created. Same with all user-pay fees - airline baggage and other charges, toll roads, bank charges, school supplements, etc. Symptomatic of our value extraction economy, where you are viewed as creating value even if all you do is rip off others.

  207. The facility fee was originally designed by Medicare to compensate hospitals for the added cost of outpatient care in that setting. They then broadened the definition to include hospital outpatient settings far removed from the hospital. Medicare also required the facility to charge that fee to all their patients, if they charged it to Medicare patients. Basically a huge and unjustified rate increase in which Medicare was instrumental, now loved by hospitals who are buying up practices as fast as they can so they can impose the facility fee on top of their usual charge. Hospitals grow fat and rich as patients are gouged and impoverished. I bailed out of this increasingly rotten system and went to work for the VA, where I can watch things with clean hands and a clear conscience. Bring on Elizabeth Warren.

  208. For me, a retired General Internist, the outrage I feel is twofold. First, as a patient I consider this unconscionable double billing. Second, as a retired private practice physician I feel this represents an unfair business practice as I could never add on an extra charge for my medical services to cover the cost of my office. I was expected to pay for this from my professional fee. It is no wonder that I am no longer an isolated physician who feels it is high time for comprehensive national health insurance. One additional thought— a rhetorical query of sorts. Who among you Republicans opposed to Medicare for all but you, yourself, on Medicare would abandon it for the private Health Insurance you used to have with all its Byzantine regulations & costly premiums? I never saw a single patient of mine willing to do so. We should consider that when we’re wondering about the health care our children, grandchildren and greatgrandchildrer will have.

  209. This is yet another medical practice scam. Doctors should pay their own rent. Whether they work in their own office or one in a hospital, the doctor should pay for the use of the premises. As usual, the patient can't find out in advance about the price. Why is medicine the only business that doesn't have to tell the customer what the cost is before they buy the product?

  210. During an annual wellness check, Medicare, I made two mistakes. 1) I asked the doctor a question to which I received a one sentence reply: ka-ching - $75 facility fee; 2) the nurse asked if I had received a seasonal flu shot (no, may as well save a trip): ka-ching - $75 facility fee; the inoculation was covered by Medicare. So, two "facility fees," $150 charge during my "free" annual wellness check.

  211. @Craig51 That's appalling. Medicare doesn't cover these fees? I have not run into anything like that in my part of the country.

  212. It is not only hospitals. My internist belonged to a group practice. The practice recently sold-out to Caremount, not a hospital. I received this a few weeks ago [I am covered by Medicare.} : "Medicare pays 100 percent of the cost for this visit with no out-of-pocket expense to you. However, please keep in mind the AWV is not a head-to-toe physical because it only includes certain preventive and screening services; this means if you ask your doctor about any aches, pains, or other illnesses during your wellness visit, you may have a copay or deductible." You have to love this. To top if off, Caremount did not include all my past test on their so-called patient portal: no longer am I able to look a past blood test results.

  213. @Alan: Regarding past test results, I ALWAYS get a hard copy of every/any tests (bloods, x-rays, etc.), and a copy of the surgical report for any procedure I have - I scan it into MY OWN COMPUTER. By doing this, I have most of my medical records available to me, 24/7, for free. (You could just keep all of it in a file folder in a drawer if you don't want to put it on your computer.) Let me add that I do not trust any "patient portal" in the least. The whole game is rigged, as far as I'm concerned. How long until there's a "patient portal fee"?

  214. I had a hernia repair in a surgical facility in North France in 2014. I was scheduled for surgery a week after I first consulted the surgeon. I arrived very early in the morning, was prepped and taken to to operating room, then returned to recovery, and since I was doing well by 7:00 pm, discharged that evening. There was a facility fee for the operating room, but the total bill — surgeon, anesthetist, nursing staff, pharmaceuticals and everything else — was less than 2000 euros, about $2200. That was the entire bill, not my portion after the insurance paid its part, and it included all follow-up visits to the doctor and the cost of a nurse who arrived at my apartment every evening to check the incision and change the dressing. It goes without saying that I had no complaint about the facility fee.

  215. I’ve consulted many physicians in France over the years. Most practice out of an office that is really an apartment unit in a residential building. One of the rooms functions as the waiting area, another the consultation room/office. There is no receptionist, no nurse. Just the doctor, who makes her/his own appointments, takes vitals at the beginning of the visit, listens to the problem and then makes a diagnosis, writes prescriptions, and collects the fee (23 euros) at the end. I’ve never encountered a ‘facility’s fee’. This is why I appreciate French medical care, and why I am completed turned off by the layers upon layers of administrative bloat that we have added in the United States.

  216. @Concerned Citizen Primary care doctors, pediatricians and geriatricians average no where close to that amount. This partly accounts for the relatively small percentage of medical students going into those fields.

  217. @Concerned Citizen Insurance CEOs make $60,000,000 [Aetna], Hospital administrators [MBAs, not doctors] make $12,000,000 [Mount Sinai, NY], Plaintiff malpractice lawyers several million [difficult to find documentation], News anchors $36,000,000 [Hannity]. Perhaps a physician, after 7-12 years of postgraduate education, taking 24 hour call, visiting patients on an emergency basis, making decisions which are constantly subject to second-guessing and threat of litigation making a few hundred thousand is not overpayment, relatively speaking. Suppose your physician was as effective as your congressman, how would that be?

  218. What is being missed by all the comments blaming greedy doctors is that the facility fee does not go to the doctors and is not charged by the doctor. This was implied by the article but not explicitly made clear. Private doctors cannot charge you a facility fee. Facility fees are charged by the hospital to the patient for using their facility in addition to whatever is charged by their employee doctor. The facility fee is charged by the hospital and the money goes to the hospital. The doctor has no say in it and does not receive it. As a physician I stopped performing procedures at a local hospital owned procedure suite because of the 1000s in facility fees that were being charged my patients. I started performing the same procedures in my own office where I do not have the benefit of a facility fee to purchase and maintain the equipment and hire the staff. Even though it is expensive to do it in house rather than allow the hospital to charge a facility fee to provide that facility to the patient I would rather I cure the cost and do that rather than have my patients made responsible for thousands of dollars in expenses. So to all the commentators who are decrying greedy doctors please have an understanding of the system and fee being discussed here and realize that it is a hospital charging you a fee independently and without any benefit to the Doctor who is seeing you

  219. Sounds like yet another scam surprise billing that is out of one's control. How are you supposed to know to ask about a facility fee if you do not read about it in The NY Times? It's like buying a car where they have a long list of ADP (Additional Dealer Profit) items - like advertising, rust proofing, etching, etc. Maybe car dealers will add a facilities fee too! At least you can walk away from a dealership. I have confronted recent surprise bills from all kinds of businesses after the fact and without warning. There should be a law!!! We should not be forced to pay a bill we were not warned about BEFORE getting the alleged service, giving us a chance to opt our or find another solution. Imagine if nytimes.com suddenly added a cyber fee for accessing one's subscription online the previous month!

  220. ANOTHER SCAM being perpetrated on unwitting patients. Are you kidding - a "facilities fee" - should we now request our exam take place in the parking lot? I've never seen such a thing in our area - Doesn't the fee you pay the hospital, clinic etc cover everything - including overhead? What's next - airline style pricing - it costs x dollars to walk into the door, the x if you actually want to see a doctor, and then x dollars if you want surgery in an actual operating room...and on and on. This is madness.

  221. This facility fee is only a way to increase the hospital's revenue. Case in point. My wife was seeing a pulmonologist in Ft. Lauderdale who had a private practice in a building owned by Holy Cross Hospital. The bill she received was for a standard existing patient offic visit until -- until he sold his practice to Holy Cross Hospital. Now I do not know how much he sold it for but from that point onward, he was a hospital based physician and not in private practice. I assume the hospital paid his salary and then began charging facility fees. It must have been a good deal for him because he no longer had to pay rent on the office space, he no longer had to hire employees (they become employees of the hospital), he no longer had to bill insurance companies (the hospital took care of all of that). So, this is really what is happening. A few months later, my wife's cardiologist also sold his practice to Holy Cross Hospital and you can guess what happened. Now, also you should consider that I know all about this scam because I ran a medical billing company for 20 years.

  222. This article and the comments are misdirecting our frustrations and anger. Doctors and hospitals aren’t the ones making excessive amounts of money off of this fraudulent business model—the insurance companies are! Stop blaming doctors and hospitals for the fact that our for-profit insurance companies have taken over.

  223. Ask my brother in law how much he makes as a hospital administration stooge. He gets rewarded for cutting costs and raising fees, and his annual compensation rivals that of specialty physicians. So yes, hospitals are sometimes making hand over fist. And some doctors are. I think we can point fingers at many in our medical system, not just insurance companies.

  224. @LM I actually think they're all to blame.

  225. These fees have nothing to do with health insurance!

  226. Sounds as if it is time for Medicare for All or Universal Healthcare

  227. I have a diabetic relative that gets an annual eye exam (paid by Medicare) by an opthamologist. During this exam, a technician also checks her eyeglass prescription and eyesight. This office will not give out the eyeglass prescription, but instead, requires another appointment to do the same exam (for another fee). The double-dealing, greedy and excessive fees that medical offices charge are complete wastes of patients' money. No other country in the world spends so much or wastes so much $$ on frivolous spending on healthcare.

  228. Get a new doctor

  229. Another article that reminds Canadians that while there are things we don't like about our system, we certainly wouldn't want one that's more like the one in the US. For Americans that don't know, up here we don't directly pay anything to see a doctor, whether that visit is in hospital or an office. We don't pay for labs or imaging. We don't pay for an ambulance. In the province where I live, we do pay for medications, but only if family income is high enough to afford them. Perhaps that why people live longer here!

  230. Beware the doctor who offers you a vaccination for something you can get at any drug store. The list is long and includes most vaccines. At this time of year beware the parting offer of a flu shot. Doctors' offices tack on facility fees and doctors' fees even though the nurse gives the shot. They may or may not stick their head in the door. I have heard may seniors complain of this scam costing them a lot of money when the local drug store takes your insurance payment, medicare included and that is it.

  231. You’d like to think we get reimbursed for vaccinations but we generally do not. I’m sorry it’s that way. I certainly invite you to go to pharmacies for services covered there. We also are not paid what we bill but increasingly a vanishingly small portion and often with flat out refusal to pay at all. I’m not kidding.

  232. This is just crazy. I just don't see why state-side Americans put up with the US health care system. I live in France. When I go to my GP, it costs me €25 (about $28). Some weeks ago, I broke my little toe, and since it was the weekend, my regular physician wasn't available, so I went to the emergency room at the nearby hospital. (I would have ignored it except the toe was sticking out sideways). X-rays confirmed the fracture, and I was sent home with a prescription for anti-inflammatory drugs, pain reliever, and a special shoe to keep my toe elevated. Total cost : €10 (co-pay for the shoe). Of course we pay higher taxes here, but it's a progressive scale where the more you earn, the more you pay. And it still works out much, much cheaper than in the US. Most costs are covered by the national health care system, which includes hospitalization, about 65% of prescription drugs, most doctor's visits, lab work, etc. I pay about $170 for supplemental insurance that covers both my wife and I, with no deductible and no or very small co-pays; it covers things like 100% of prescription drugs, private room for hospitalization, and a significant portion of eye glasses and dental work. Get with it, America! Learn from how other countries handle the right to health care!

  233. @John Matthews I should have specified: my insurance payment is $170/month

  234. @John Matthews Its not all doom and gloom. My employer offers great health insurance plan, $25 office visits, free tests, $10-25 for meds, no surgery or hospital fees (I think ER trip may be $100). I have kids and each coat $55 to $100 total. I pay about $90/week for family plan. One PROBLEM is that this is not available to all and my company (non profit) chips in a great deal of the costProbably a major reason they have little turnover. I just wish everyone had my option. My state was the leader and first in Affordable mandated insurance for all, I have never had a bad option. Other problem is that private insurance companies take a large chunk of HC dollars, they need to make money. Government just has to break even.

  235. @Momsaware Look up what the top exec's make at the top 100 healthcare companies and insurers. You can see where the bulk if the money goes. Compare that to what is paid out in other industrialized countries

  236. The most effective thing we can do to control costs is require all medical providers to publish their prices for visits and services and procedures. This idea of it all having to be closely guarded secret revealed only after such are provided is the worst kind of fraud.

  237. @Homer D'Uberville A straightforward app - enter diagnosis code and procedure code and read out the copay/coinsurance $$.

  238. Another example--as if we needed more examples--of the insanity and dysfunction of the health care "system" in the United States, where costs multiply in order to compensate administrative middlemen, where costs bear no relationship to quality of care, and where every party (patients, providers, payers, government, employers) think the other parties should bear the costs. And yet, better and simpler systems, whether that is the Affordable Care Act or more radical single-payer proposals, are criticized for being too expensive or too complex, as if everyone (or anyone) was well-served by the current state of affairs.

  239. Welcome to my my home! But before you enter, I'm going to need you to give me the $20 facility fee I will use to redo my kitchen. (Though a wonderful example of how ridiculous this system is, this one is more honest because I am asking for it upfront.)

  240. Are they going to start charging for parking in the lot that the building owner also owned?

  241. @Joe Schaal. In Houston we already have to pay for parking at most Dr. offices. I have paid up to $17.00 to park in the Medical Center. That is in addition to co-pays and facility fees.

  242. @Joe Schaal People have to pay for parking in many places. For some who need to make regular visits to a health care facility for services like chemotherapy it can cause great hardship. But, as we are constantly told Americans don't want the government to come between them and their doctors. We all just love our private insurers.

  243. I appreciate you irony...

  244. The article ends with advice to use walk-in clinics as a way to avoid facility fees for minor health problems. However, there are many many “walk in clinics” that are owned by hospitals and that also charge facility fees. No matter whether a location calls its self a “walk in clinic” or an “emergi-center” or an “urgent care center” always check about facility fees and if the place is owned by a hospital, find out if it will bill your care as an “out patient procedure” ($$$).

  245. We are all fools when it comes to healthcare. We are the customer!!!! We need to demand to know the cost of the service prior to the exam or procedure and what portion is not covered by the insurance. What other business can’t give you a price before you spend the money? Where else can a doctor claim to accept your insurance, then send you a bill because the insurance doesn’t cover the procedure they knew they were going to provide? The doctor literally does these procedures over and over again and they don’t know if it is covered by insurance but you, who have probably never had the procedure and have no clue what health insurance covers, are responsible for uncovered fees? It’s absurd.

  246. @Billy Bobby Vote for Warren and make sure every one you know does the same. Also, vote for democrats for the senate & house as well. As long as republicans are calling the shots - everything will be more expensive, unless you are a corp or super rich. If you add up what insurance costs with co-pays, pharmacy, dental, etc. everybody paying more in taxes will be much cheaper in the long run.

  247. @Billy Bobby Except that there's a good chance the doctor doesn't know (and can't find out) how much you'll be charged. Also, unlike most other services, it's not clear just what'll have to be done in many situations.

  248. The insurance companies play a shell game, constantly changing what they will cover and how much they will cover. It is literally impossible for doctors who take insurance to have any idea what the patient will be billed. As a doctor who is incredibly upset by the bills my patients receive, I am daily trying to figure out a way to get away from dealing with insurances and still give care to all who need it. The stress and unhappiness makes me sick in my heart.

  249. Surely everyone loves this healthcare system, it’s so transparent and not at all stressful! What better time to shop around than when you’re sick I ask?

  250. This is extortion pure and simple. As a pensioner in a rural area of NZ, I pay $28 to go to the doctor and all x rays, blood tests etc are free, and if it is an accident, the ACC pays. Admittedly we have long waiting lists for non-urgent surgery but if you are really ill or in a life threatening situation, you are given top-grade care, straight away, free in a public hospital. (Private insurance is expensive and really only an option for those on high salaries and means that they do not need to wait for non-urgent surgery.) Taxation at its' best.

  251. @Robin A lot of Americans have to wait for medical care too. When my brother had his leg amputated below the knee his stump got badly infected. The surgeon's office wouldn't give him an appointment for over two weeks. He went to the ER and the doctor said that if he had waited for two weeks he would have lost the rest of his leg. I waited two years for a hip replacement and had to endure such incredible pain I could barely think straight. I couldn't even get any adequate pain medication because of our arcane laws that assume everyone is a raving drug addict.

  252. I am oh so glad I moved to Canada.

  253. You will find that your new plan has it's own special kind of shortcomings.

  254. @Urban.Warrior I invite you to spend a week with me in Canada and see for yourself.

  255. Thank you for this. I just learned about facility fees and needed such an explanation. Oy vey, what next to keep me and others from seeking medical care unless we are in dire straits?

  256. @Lynne Shapiro I checked out a specialists I just visited. and they did charge me a facility fee for my visit at an office at a hospital building even though no special hospital equipment was used. The tiny office could have been anywhere. I also saw a resident and didn't get great care. However, I see my Medicare C Advantage plan did cover the $218 facility fee charge this time, but what about other times?. This is scary as some of us older adults who don't drive need to go to medical offices in hospitals that are transit reachable as this one was. Facility fees like this especially for those many of us no longer with fixed pensions and with wiped out 401K plans in 2008-2009 will really be harmed financially.