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If you have health insurance and you see a doctor, you probably fork over your copayment and think insurance will cover the rest. Unfortunately, many doctors and hospitals have begun tacking on nuisance fees, which many health insurance companies won’t pay.
All that paperwork you’ve signed with your doctor’s office says that you’ll pay whatever fees insurance doesn’t cover, so you’re stuck with a hefty bill that nobody told you about ahead of time.
I have heard about this from friends and even encountered it once with a specialist my husband saw several years ago. I called to contest the $200 “facility fee” they’d invoiced us for – even though my husband had dutifully paid his $50 copayment at the time of service.
The person I spoke with agreed to waive the fee as a “one time courtesy.” That was fine, since there won’t be a second time.
Nowadays, my family tries to avoid specialist doctor visits with practices based in or affiliated with a hospital or large clinic. They seem to be the most likely to tack on extra charges such as a “facility fee,” “clinic fee” or “trauma fee.”
Hospitals, clinics and practices which add these fees are simply hitting up their patients for more money to cover their overhead and profit, as health insurers squeeze them to become more efficient and to justify their high reimbursement rates.
How to Avoid Sneaky Doctor and Hospital Fees
To avoid such fees, be sure to ask ahead of time when you make the appointment whether any extra fees will be charged on top of your insurance copayment (or your self-pay amount). If the appointments scheduler doesn’t know the answer, ask to be transferred to the insurance billing department. Write down the name of the person who gives you an answer.
If you find that a doctor’s office charges a facility fee or other unusual fee, and you were referred by another doctor, such as your internist, family doc or pediatrician, you can request a referral to a different practice. Make sure to tell your doctor why you refuse to patronize the practice that charges the sneaky facility fee.
What If You Get Charged an Extra Fee?
If you do receive a bill for a facility fee or other nuisance charge which your health insurance doesn’t cover, try calling the practice’s insurance billing department to complain. Do so in a polite and calm manner.
Keep in mind that the insurance billing folks probably had nothing to do with the decision to charge a facility fee, and certainly none of it goes into their pockets. They may or may not have the authority to waive the fee. If they can’t, you may want to ask to speak with a manager.
If you can’t convince the medical practice to waive the facility fee, try calling your health insurance company’s member services number. Some insurance carriers include language in their contracts with doctors that keep them from charging anything above a patient’s regular copayment.
Even if you manage to somehow get out of paying the fee, you’ll find yourself charged it again if you keep returning to the same medical practice. You’ll probably need to either resign yourself to paying the fee for each visit or find another doctor.
More About Extra Fees
I should note that these extra fees are not related to the Affordable Care Act, commonly known as “Obamacare.” I first heard about them around seven years ago and had my own experience with a facility fee shortly thereafter. Over the years, more practices have become aware that they could get away with charging these extra fees and have jumped on the proverbial bandwagon.
If you have Medicare, providers are required to tell you ahead of time of any charges you will incur. Apparently, not only do most private health insurers refuse to pay these fees, but they don’t require providers to tell patients about them, either. Unless you know to ask ahead of time, you’ll find out about the fee when you get a bill in the mail.
I still can’t figure out how doctors’ offices continue to get away with charging a facility fee or other extra charge. If you got an unexpected bill for $200 from a doctor, would you pay it, or complain?