Care Triad

Making patients pay more

Medical bills are not designed to make sense to the patient. In fact, as I’ve written before, they are almost impossible to understand, even when the charges are explained by the billing office.

So it’s pretty easy for hospitals to add charges to the bill without the patient really knowing. One popular way is to add a “facility fee”.

My daughter in on a medication that is given once every 2 months. She goes to the doctors’ office building that is connected to an academic medical center where the medication is given through an IV over the course of a few hours. The staff members in the infusion center know her well and her doctor often stops by to say hello while she is there.

A few months ago the infusion center moved to a new building with lots more space and private rooms for the patients. The doctors and patients all anxiously awaited the opening of the new space although it was a block away. What the hospital administrators did not tell the doctors or the patients was that they would be able to charge patients more money because the new infusion center is considered to be in a “hospital outpatient” setting (instead of a “doctor’s office”). This new charge is called a “facility fee”.

So at the last minute we learned that our (already substantial) copay would double.

Interestingly, one health system in the Cleveland, OH area launched an ad campaign to promote the fact that they do NOT charge these same “facility fees” that their competitors are charging.

Here’s an excerpt from what they say on their website:

Just because you can, doesn’t mean you should

Did you know that hospital-owned physician practices have the option of charging you something called a facility fee? It’s like charging you rent for your exam room in addition to your doctor’s visit and laboratory test. These facility fees are pushing health care costs two to four times higher than needed. At Mercy, what you see is what you get.

Lots has been written about the high costs of healthcare in the United States including an ongoing series in the New York Times with a recent article about colonoscopies. Bills for a colonoscopy vary from state to state and from hospital to hospital (and are much higher in the US than they are in other countries).

But most people don’t realize that the same procedure done by the same doctors in the same hospital can result in a different bill depending on where in the hospital the procedure takes place.

So shortly before my daughter’s scheduled treatment in the new infusion center, we got a call from her doctor apologizing that he had just learned that our out-of-pocket costs would double. He told us that the pharmaceutical company has a program to reimburse patients for the cost of the drug. The program is for anyone with health insurance and is independent of financial need.

But the program (not surprisingly) requires documentation that the drug was actually given. Unfortunately, because the care is now (technically) given in the hospital, the bill is now generated by the hospital. And the hospital does not itemize the specific drug that is given. I’ve been working on getting the hospital to send me an itemized bill for a few weeks now.

Wish me luck.