DENVER (KDVR) — Solving a Rubik’s Cube might be easier than deciphering your last medical bill, and facility fees are often a big reason why.
These are the fees hospitals charge patients to cover operational costs like front desk staff, nurses and emergency room equipment, not for the doctor’s diagnosis or treatment. They may be included in your bill, but they’re not always identified as such.
Yet, facility fees are often more expensive than the doctor’s fee even when you don’t visit your doctor at the hospital but at a doctor’s office or clinic.
As hospitals have bought up private doctor practices, they have imposed facility fees at practices that may not even be located in the same neighborhood.
Now, the National Academy for State Health Policy is doing an analysis of what’s called the All-Payer Claims Database in the states of Washington and Colorado to determine what effect facility fees may be having on health care costs.
“We know that consolidation is a driver for all increasing health care costs and the level that facility fees play a role in that is what we’re trying to understand,” Maureen Hensley-Quinn, the senior program director of coverage, cost and value for the NASHP, said.
Hensley-Quinn’s organization hopes to complete its analysis sometime this summer and then offer state lawmakers information that might lead to a reduction in facility fees.
“State health officials that we work with feel like it is inappropriate for these additional fees to be charged,” she said.
Where are Colorado hospital prices posted?
A recent report by the nonprofit Patient Rights Advocate found many Colorado hospitals aren’t meeting the federal mandate requiring hospitals to post their real prices online.
Cynthia Fisher, the CEO of Patient Rights Advocate, told the Problem Solvers a large majority of Colorado hospitals continue to hide the cost of care from consumers, including facility fees.
“They’re finding all sorts of different ways to be able to upcode and upcharge and maximize their revenues at the expense of the American worker,” Fisher said.
Multiple FOX31 viewers have pointed to Children’s Hospital Colorado as a prime example.
Children’s Hospital provided data to the Problem Solvers that shows its facility fee list price for a 60-minute behavior health visit is $395, although no one pays that amount.
People without insurance who self-pay are charged $256.75 and people with insurance are expected to pay less.
The out-of-pocket cost for Anthem customers is $109, for United Healthcare it’s $104, Kaiser Permanente is $99, Cigna is $104 and Aetna is $60.
But those figures don’t square with FOX31 viewers like Michael Kark who had to pay Children’s Hospital Colorado $503 out of pocket based on the same CPT Code of 09837 that Children’s Hospital Colorado provided the Problem Solvers.
Castle Rock mom Brittany Tesso was charged $847 for a facility fee even though her son’s appointment with Children’s Hospital was a telehealth visit.
In a more recent story, FOX31 featured an Aurora mom who was billed $611 for a facility fee from Children’s Hospital Colorado.
When the Problem Solvers asked Children’s Hospital to explain the discrepancies, we were emailed the following statement:
“As we’ve shared previously, medical bills from Children’s Hospital Colorado are based on the cost, level, length and type of care that is provided. If a patient meets with multiple Children’s Colorado employees (e.g. OT, speech, PT, learning) or has a more comprehensive assessment during a single visit, the charge will reflect the services provided and be higher.
“The amount the patient owes will depend on their insurance plan and can include deductibles, co-payments and co-insurances. If a family has not yet met their deductible, they could have a higher out-of-pocket responsibility because of their health plan. We gave you a breakdown of the specific service you requested for the most common out-of-pocket maximums that families will pay, after their deductible is met.”
How much are behavioral health facility fees?
FOX31 asked the largest hospital groups in the Denver metro what they charge for a facility fee based on a one-hour behavioral health visit (CPT Code 90837).
HealthONE and Centura Health both told the Problem Solvers they don’t charge facility fees.
UCHealth said it doesn’t offer one-hour behavioral health visits at its hospitals, but some off-site clinics that do typically add about $19 to a patient’s total bill to cover facility fees.
SCL Health hospitals said it doesn’t charge facility fees at its hospitals but some of its special clinics do, usually about $175 after discounts are applied.
Denver Health said its facility fee is $184 for those who self-pay, and closer to $105 for those who have insurance unless you’re an Aetna patient who then has to pay $228 out of pocket.
“Blindfolded highway robbery, and that’s why these facility fees and every single upcode or any other charge needs to be relayed to the patients in advance of care it’s our right, it’s the law,” said Fisher, the patient advocate.
Federal law now mandates that hospitals post prices for most of their common procedures online, though the PRA report found only about 14% of hospitals nationally do a good job of this.
The NASHP has created model legislation for state lawmakers that could reduce facility fees, including a ban on facility fees for providers that are located more than 250 yards from the hospital that owns them.
The Colorado Hospital Association acknowledges facility fees can vary for a number of reasons. The CHA recommends patients call their insurance provider before any appointment since insurance contracts with providers often determine which doctor, lab, or clinic might offer the most reasonable facility fees.