From the Fall 2011 For Your Benefit pdf format of fybfall2011.pdf
newsletter

If you visit a doctor at a hospital-based office, be aware that hospitals sometimes charge a facility charge in addition to the physician, x-ray and laboratory charges. These charges can range from $25 to hundreds of dollars per visit.

Physicians that practice in free-standing non-hospital-based settings usually include these overhead costs into a single office visit bill. And sometimes, even though you are seeing a doctor in a hospital-based office, the hospital will not charge this fee. The practice depends on the hospital's ownership structure, choice of approach and contracts with insurers. In part because of lawsuits and new laws in some states about transparency of these fees, more providers are prominently displaying signs in their offices if they charge a facility fee.

Alan Sager, a professor of health policy and management at the Boston University School of Public Health said in a recent Wall Street Journal that facility charges "are the latest gimmick to generate additional revenue for hospitals." On the other hand, hospitals that charge these fees say they are necessary to offset overhead, including higher staffing, equipment, and utility costs.

The GIC is working with our health plans to try to eliminate this practice, but until this practice ceases, members sometimes are responsible for paying facility charges, often as part of a calendar year deductible charge. Here are some steps you can take to help avoid these charges:

  • When you visit your doctor, ask if you will be getting a separate bill from the hospital. If the doctor's office says you will, let the staff or doctor know that you are not happy about the additional charge. If providers hear from members that they are not pleased about these charges, they may be able to reduce or eliminate them.
  • Ask your doctor whether he or she practices at a non-hospital based setting where there would not be a facility charge. Consider booking your visits at these alternate locations.
  • Review the Explanation of Benefit (EOB) you will receive from your health plan if a service is subject to a deductible to see if the deductible charge was the result of a hospital facility charge. If you are not sure, contact your health plan. If you receive a bill from a hospital for this charge, call the hospital and express your concerns about the charge. Sometimes hospitals will respond to these complaints.

This information provided by the Group Insurance Commission .