DENVER (KDVR) — The FOX31 Problem Solvers have reported on questionable “facility fees” before, but never one that was more than $2,500.
“Two thousand five hundred and eighteen dollars for walking through the door,” is how Ben Los described the bill he received from Presbyterian/St. Luke’s Medical Center in Denver.
The Colorado Springs dad and his wife took their 5-year-old to see a pediatric neurologist at Presbyterian/St. Luke’s Medical Center in September, where the couple’s son was diagnosed with absence seizures, a treatable condition that children generally outgrow.
Los expected a bill from the doctor but his family was never warned the hospital would send a separate bill for “hospital services” even though his son never spent a night at the hospital, he just happened to visit a doctor located at the hospital.
“Presbyterian/St. Luke’s from everything I can assess is just padding its bottom line. I would go so far as to say that it is a scam that they found a legal loophole and can get away with,” complained the 37-year-old father.
What the hospital charged for
Los said he had no issue paying the doctor’s bill for his son’s 90-minute visit and EEG brain scan, which after insurance kicked in, required Los to pay $238 out of pocket.
But he had no idea what the hospital bill of $2,518.50 was for, only that his insurance company wouldn’t contribute a penny towards that bill until he met his family deductible of $10,000 for the year 2022.
When Los reached out to the hospital, he said he could never get a straight answer as to, “Why this astronomical fee even exists in the first place?”
Response from Presbyterian/St. Luke’s Medical Center
In a statement to FOX31, Presbyterian/St. Luke’s Medical Center said:
While we cannot speak specifically to a patient’s care or bill without their written consent, we can confirm that an electroencephalogram (EEG) does NOT incur a facility fee. A billing statement received from a hospital would be inclusive of the hospital procedure and all related hospital services. In addition, physicians would bill for their specific services directly to patients separate from the hospital bill.
The amount patients actually pay for hospital services has more to do with the type of insurance coverage they have than “prices” or “charges.” The move toward higher-deductible insurance plans has put a strain on many of our patients, but we understand their choice to pay a lower monthly premium, and we also understand their frustration with the larger out-of-pocket expenses they may experience as a result.
Patient advocate weighs in on medical fees
“I don’t think we’ve ever seen a facility fee this high,” Adam Fox with the Colorado Health Initiative said when the Problem Solvers showed him the $2,518.50 bill.
“I think it is incredibly egregious that somebody received a facility fee like this for a pretty routine imaging service and were not told in advance that they were going to be charged a facility fee or that it was going to be $2,500,” Fox said, whose organization advocates for consumers and patients.
Fox told the Problem Solvers that facility fees have spread among Colorado hospitals especially after 2019 when the state regulated what was known as “surprise billing,” which inflated bills for using out-of-network doctors.
But in the case of 5-year-old Alexander Los, he went to an in-network doctor at an in-network hospital, where his parents were told his services would be covered by his insurance plan and to a large extent the doctor’s services were covered.
But what Presbyterian/St. Luke’s called a hospital services fee and what others in the health billing field often call facility fees were not. Those charges generally cover the hospital’s equipment used by the doctor to treat a patient, in this case, the electroencephalogram.
Parents like Los, say facility fees feel a lot like a surprise bill, “Absolutely. I was not told about this. It was there’s nothing you can call it besides a surprise bill.”
“The insurance companies don’t really have much incentive to fight these facility fees because the patient is the one that’s on the hook,” Fox said.
The Colorado Health Initiative plans to lobby lawmakers this legislative session to crack down on facility fees by regulating when they can be applied and by how much.
“We want to make sure that consumers are protected from really what is a new form of surprise billing with these facility fees,” Fox said.
Lawmakers working on changing legislation
“I think this is something that the legislature can address, at least for forcing transparency for the hospitals,” Representative Brianna Titone added.
The House Democrat (District 27) who represents northern Jefferson County, said hospitals should be forced to tell patients at the time of service if they’re going to be billed a fee separate from the doctor’s bill and generally how much it might cost.
Presbyterian/St. Luke’s Medical Center is owned by HealthOne which is owned by HCA Healthcare, which in the first nine months of 2022 reported a net income of more than $3.5 billion.
“I think we’ve seen the hospitals make quite a bit of money. So what’s this extra fee all about? Why is it necessary?” Titone asked.
“If you can get away with it and you can make more money, it seems like that’s what the hospital’s going to do,” Los said.
Problem Solvers get response from hospital
After the Problem Solvers made inquiries, the director of patient access for Presbyterian/St. Luke’s Medical Center called Los and said the hospital had agreed to reduce his bill by 75%, which would lower the $2,518 bill to about $629.
A spokeswoman for HealthOne told investigative reporter Rob Low over the phone that Los was not charged a “facility fee” but instead was charged a “hospital service fee.”
When the Problem Solvers suggested those sounded like the same thing, the spokeswoman insisted HealthOne did not charge facility fees for outpatient visits but did not clarify how a “hospital service fee” is in any practical sense, different from a “facility fee.”
Los said the director of patient access for Presbyterian/St. Luke’s told him the “facility fee” was actually a “facility charge” but again Los said it was not explained to him how the two terms were meaningfully different.
Fox told the Problem Solvers there is no difference and said he saw “no daylight” between a facility fee, a facility charge or a hospital service fee and that hospitals are using facility fees to pad their earnings.
Rep. putting together bill to regulate fees
Colorado State Representative Emily Sirota (D-District 9) told the Problem Solvers she’s in the early stages of crafting a bill to regulate facility fees and hopes to introduce the measure sometime in the 2023 session.
“Coloradans face sky-high health care costs, from expensive insurance premiums to costly prescription medications. Struggling families can’t take any more surprise fees and bills, and these facility fees often amount to big surprises for many Coloradans,” Sirota said.