Check your doctor’s bill: You just might find a whopping facility fee

When you have an outpatient medical procedure, pay attention before you undergo treatment. Floridians report being blindsided by hospital charges called facility fees for procedures that didn't require a trip to a hospital.

A Broward woman went for a hearing test at a Weston office owned by Cleveland Clinic Florida. The test cost her $409. Walking in the door cost her another $680 billed as a “facility fee.”

A West Palm Beach senior citizen underwent cataract surgery at a clinic owned by Tenet Health. The procedure cost him roughly $3,000. Walking in the door cost him another $900, billed as a “facility fee.”

“When you do almost anything outpatient, be aware of what you are signing and agreeing to,” said Dr. Steven Ullmann, professor and director of the Center for Health Management and Policy at the University of Miami Herbert Business School. “Most likely you will be charged a facility fee.”

Floridians report being blindsided by hospital charges called facility fees for procedures that didn’t require going to a hospital.

The increasingly common facility fee can range from $100 to $1,000 — or more.

“Facility fees are similar to booking a hotel room and then being charged an additional resort fee when the bill comes,” said Keith Dean, executive director of Floridians for Affordable Healthcare, “Shouldn’t they disclose and be transparent about the actual full cost for the room up front when I am choosing the resort I want to stay in?”

In Florida, health systems have been expanding, buying physician and specialty practices, and opening urgent care, imaging, and ambulatory centers. They have crossed county lines to keep pace with Florida’s growing population, and as they do so, an office or clinic previously owned by physicians now becomes the outpatient department of the hospital in terms of  billing. To help pay for overhead costs, the health systems tack on a facility fee unrelated to medical care charges billed by doctors.

Someone who previously got an echocardiogram at their cardiologist’s office may suddenly find a facility fee charged for the test in the same office, which is now owned by a hospital.

Many insurance plans do not cover facility fees for outpatient services, or cover only a portion.

“If you get something done at an outpatient facility, you could get hit with three bills, one from the doctor, one from the anesthesiologist, and one from the facility,” said Paul Fronstin, director of health benefits research for the Employee Benefit Research Institute. “If you haven’t hit your deductible, you can get hit with a co-pay for all three.”

“Typically, they want the payment upfront,” Fronstin added.

The additional fees come as Florida already ranks as a top state for medical debt and where residents pay some of the highest insurance premiums in the country.

This controversial billing practice has infuriated Floridians airing their grievances on social media.

On Reddit, one Florida mother of a 3-year-old born with congenital hypothyroidism describes her fury.

“We now see ta specialist at least three times a year,” she wrote. “Beginning June of last year, we started seeing three different bills coming through to us — one for lab work that is needed to get her thyroid levels verified, one for seeing the specialist and the newest one referred to as clinic fees of $306. When I inquired about the $306 I was told this is outpatient facility fees.

“I don’t understand how my daughter’s routine visits are now suddenly classified as outpatient visits.”

Dean of Floridians for Affordable Healthcare says he, too, finds the charges unreasonable.

“Facility fees aren’t related to the actual medical care being provided. Patients shouldn’t have to pay more based on who owns the provider’s practice,” he said. “Fair and transparent billing can help to substantially reduce healthcare costs. With Florida being the fourth most expensive state for healthcare, we don’t need inflated medical billing practices adding to the problem.”

A state law requires hospitals to notify patients about facility fees in advance of a medical service. However, the notification often gets buried in the paperwork that a patient signs.

The Ambulatory Surgery Center of Boca Raton posts Florida’s Patient Transparency Law on its website and addresses its facility fee.

“Billing for the facility and physician(s) are separate,” the website says. “The surgery center charges include use of the operating room, equipment and supplies for surgery. You will be billed separately for the services of your surgeon, anesthesiologist or other provider (if applicable).”

Cleveland Clinic Florida explained the reason for its additional facilities charge:  “These fees help cover services provided to patients and substantial costs to meet required Medicare quality standards.”

If you visit an Emergency Department, beware: A recent KFF analysis found patients are getting hit with escalating facility fees for simply walking in the door. The amount of those fees is rising faster than the cost of the medical services a patient likely will receive in the ED, the analysis found.

Some states are cracking down on facility fees, restricting the additional charges. For example, Connecticut, Colorado, Maryland, New York, Ohio, Texas and Washington all passed laws either restricting or banning facility fees on patient’s medical bills.

Florida law requires facility fees to be included in good faith estimates provided to patients.

A spokesman for Florida Blue said eventually, these facility fees lead to higher costs for insurers and patients.

“When health systems treat physician offices or ancillary locations as part of the hospital, both the overall cost and the member cost share go up,” said Florida Blue spokesman Jorge Martinez. He added that a report by his company shows  billing the same amount for the same service regardless of site of care   could result in substantial savings for employers, employees and patients — as much as $500 billion over the next decade.

Under Original Medicare, facility fees are a covered service, and the patient is responsible for 20% of the charge. Medicare Advantage Plans also cover facility fees, but there is no requirement as to how much of the fees the plan must cover.

“Sometimes, even the doctor doesn’t how much the facility fee is going to be,” said Ullmann at the University of Miami.  “The concept of not knowing exactly what the fee will be until after a procedure is different than any other consumer consumption that goes on. It’s baffling for the consumer.”

Ullmann says Floridians likely will push for more transparency as they become aware of facility fees, and may even shop around.

Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.