Community Chat

[PinkSunset]

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@CouponQueen wrote:

Thank you for posting this. We often think we are informed in many areas and something new crops up that we hadn't heard about.

I have never have encountered this "facility fee.." but anything is possible in the future and it is good to know ito look out for it.

I was surpsied that this wasn't new and that others have encountered this also..so it is always good to put info out there as who knows who else can get a heads up on it.

That said - I loved these types of threads with a topic and various responses and experiences.  

I am sure we are ALL glad that we have what we have - nobody said anything different - including the OP that she was less than thankful for her insurance... Just shocked and surprised at this outrageous fee.

What of patients who can't afford that fee? What of patients who are on Medicaid to begin with? 

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Medicaid pays for everything. Patients have no out of pocket expenses who are on Medicaid so they actually do have the Cadillac of insurances.

[Carmie]

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@gardenman wrote:

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@151949 wrote:

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@september wrote:

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@Pitzel wrote:

@151949

My internist's office just told me that they are going to charge $200.00 a year for filling out paperwork, doctor talking to patients on the phone and other miscellaneous things.  I think this is absolutely ridiculous.  And insurance doesn't cover this.

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Most of the long time physicians where I live are now in concierge plans.  We pay $1800/year, not covered by insurance.  Thank you ACA!

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This has absolutely nothing to do with the ACA - it is unethical doctors taking advantage of fearful patients.

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I wouldn't say it has nothing to do with the ACA. The ACA shifted a lot of costs onto private docs and many were forced into making an uncomfortable choice between joining a medical group, retiring, or finding a way to get more money upfront to help offset the increased costs, and concierge medicine is one way to do that. Digitizing all medical records was one such cost imposed by the ACA. 

To give you some idea of the costs involved, in California they're digtizing the medical records of 130,000 inmates. The total cost (as of 12/11/2016) was $400 million. That's $3,076.92 per inmate for people who are generally healthy and have minimal medical records. If you're a private practice doctor with hundreds/thousands of patients many of whom are quite sickly and have big files, and you're looking at a similar cost per patient, your options are very limited. (Here's a link to the article about the cost of digitizing the prison medical records.  http://sanfrancisco.cbslocal.com/2016/12/11/california-prison-medical-record-cost-doubles/

My Mom's old cardiologist had to join a group as the cost of putting all of his patient records into a computerized system would have bankrupted him. He had a small two person staff and thousands of files each containing dozens, if not hundreds of tests results and reports that would all have to be placed into a computerized system within a relatively short timeline. The price he was quoted by the various agencies in the area to digitize his records was more than he could afford. His patients were mostly all on Medcare/Medicaid so his rates were largely fixed and he couldn't pass on the cost to his patients. There aren't enough well-to-do patients in the area for him to go the concierge route, so he had to join a medical group and give up his private practice.

That was all a result of the ACA and its requirement to digitize all medical records. The costs that imposed on many physicians was absurdly high. A local lawyer Mom's cardiologist consulted advised him that he would have to pay someone to do it as if he used his staff and something was entered inaccurately or overlooked, his office could be held responsible and sued. By using an outside firm to digitize the records they'd be responsible for any mistake and not his office. He was also advised to keep and maintain his written records to prove that his data was correct if there should be an issue down the road. 

The ACA created a lot of problems for a lot of people and was far from a panacea. It forced some doctors out of the business completely and forced many others into big changes in how they practice medicine.

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These problems have nothing to do with the ACA.  Most of the problems are due to HIPAA laws.  Yes, we all know about HIPAA privacy laws, but there are many more laws attached to it.  Read Title II of the HIPAA laws for information,

[Carmie]

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@PinkSunset wrote:

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@Carmie wrote:

This is nothing new.  The "facility" is an outpatient surgical center that is owned by a group of doctors.

Most of these facilities do not meet the guidelines to be covered by Medicare and almost all insurance companies follow Medicare guidelines.

The insurance company I worked for used to deny claims for these facility services.

You  should be happy they told you upfront.  Some of these places don't and you get stuck with a bill you hadn't planned on paying.

There is no new law allowing them to charge this fee, but perhaps there is a law that they have to advise you of the fee beforehand 

You are wise in looking for a different facility to have the service done.  Does your DH's doctor have privileges to work at another Outpatient surgical center.... perhaps one that is affiliated with a hospital?

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then that would be like saying before you had any services performed, a billing person would have to know the charges upfront, what the doctor/hospital will be putting on the chargeticket and give you the costs. No one is going to do that.

I just say my PCP for my annual physical, my bill included labwork, her office visit charge, 2 xrays, the reading of the x-rays and the facility fee. Now before I went for the visit, how would anyone know what was going to be done and what those charges would be. Inpatient bills of course are a nightmare because there are medications, consultations with other specialists, labs, radiology, room fees, and who knows what else.

Be thankful you even have insurance these days. Self pay people would get charged the full boat with no isurnace discounts and they would be expected to pay the whole thing, unless they just ignore the bills and let them go into bad debt. 

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The billing person and the person scheduling scheduling the surgery knows upfront if they are not approved for Medicare and insurance payments. They might not know how much you will be personally liable for, but they know you will be billed for the facility fees.

Inpatient hospital bills are paid per diem.  That means the hospital gets paid per day you are there.  The bills are not itemized.  The hospital contracts with the insurance company and they know how much they will get paid beforehand.  Sometimes the insurance pays more than the actual charges and sometime they pay less.  I remember the fist time I saw a itemized hospital bill and the insurance company I worked for paid twice the amount billed. I was trying to figure out why and wanted to get this fixed.  I then found out, they were paid their contracted rate, which in this case was more than what they actually charged.

[AngusandBuddhasMom]

This article explains a lot:

http://www.beckershospitalreview.com/finance/6-things-to-know-about-facility-fees.html

[Carmie]

@AngusandBuddhasMom  That is a very good article about hospital facility fees and it explains a lot. It does not address facilities that are not associated with a hospital.

These non hospital associated facilities are not always covered by insurance and difficult for people to understand why.

[AngusandBuddhasMom]

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@Carmie wrote:

@AngusandBuddhasMom  That is a very good article about hospital facility fees and it explains a lot. It does not address facilities that are not associated with a hospital.

These non hospital associated facilities are not always covered by insurance and difficult for people to understand why.

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@Carmie I agree I came across the expense last year when I had a endoscopy and a colonoscopy at the same time. My choice was to have it done at the outpatient facility associated with my doctors group or at the outpatient facility associated with the hospital. I opted for the hospital since it was  my first time and frankly did not feel easy having the double procedure not being done in a hospital. My insurance covered more since I opted for the hospital. But I am fortunate that through my employer we have good insurance.

[MacDUFF]

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@granddi wrote:

I wish more people would tell these stories to state legislators, state insurance boards and our senators and representatives. 

These folks have cadillac health insurance policies and just cannot possibly know of how the health care system works for regular people. 

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@granddi

Oh they know, but elitists don't care about regular people.

[Drythe]

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@gardenman wrote:

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@151949 wrote:

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@september wrote:

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@Pitzel wrote:

@151949

My internist's office just told me that they are going to charge $200.00 a year for filling out paperwork, doctor talking to patients on the phone and other miscellaneous things.  I think this is absolutely ridiculous.  And insurance doesn't cover this.

---

Most of the long time physicians where I live are now in concierge plans.  We pay $1800/year, not covered by insurance.  Thank you ACA!

---

This has absolutely nothing to do with the ACA - it is unethical doctors taking advantage of fearful patients.

---

I wouldn't say it has nothing to do with the ACA. The ACA shifted a lot of costs onto private docs and many were forced into making an uncomfortable choice between joining a medical group, retiring, or finding a way to get more money upfront to help offset the increased costs, and concierge medicine is one way to do that. Digitizing all medical records was one such cost imposed by the ACA. 

To give you some idea of the costs involved, in California they're digtizing the medical records of 130,000 inmates. The total cost (as of 12/11/2016) was $400 million. That's $3,076.92 per inmate for people who are generally healthy and have minimal medical records. If you're a private practice doctor with hundreds/thousands of patients many of whom are quite sickly and have big files, and you're looking at a similar cost per patient, your options are very limited. (Here's a link to the article about the cost of digitizing the prison medical records.  http://sanfrancisco.cbslocal.com/2016/12/11/california-prison-medical-record-cost-doubles/

My Mom's old cardiologist had to join a group as the cost of putting all of his patient records into a computerized system would have bankrupted him. He had a small two person staff and thousands of files each containing dozens, if not hundreds of tests results and reports that would all have to be placed into a computerized system within a relatively short timeline. The price he was quoted by the various agencies in the area to digitize his records was more than he could afford. His patients were mostly all on Medcare/Medicaid so his rates were largely fixed and he couldn't pass on the cost to his patients. There aren't enough well-to-do patients in the area for him to go the concierge route, so he had to join a medical group and give up his private practice.

That was all a result of the ACA and its requirement to digitize all medical records. The costs that imposed on many physicians was absurdly high. A local lawyer Mom's cardiologist consulted advised him that he would have to pay someone to do it as if he used his staff and something was entered inaccurately or overlooked, his office could be held responsible and sued. By using an outside firm to digitize the records they'd be responsible for any mistake and not his office. He was also advised to keep and maintain his written records to prove that his data was correct if there should be an issue down the road. 

The ACA created a lot of problems for a lot of people and was far from a panacea. It forced some doctors out of the business completely and forced many others into big changes in how they practice medicine.

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@gardenman

While it may be comfortable to believe and complain about, not all of this was conceived of or caused by the ACA.

As someone mentioned upstream, the requirement for computerization of medical records was necessitated by the HIPAA ACT ~ enacted in 1996.  

[Lipstickdiva]

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@Carmie wrote:

This is nothing new.  The "facility" is an outpatient surgical center that is owned by a group of doctors.

Most of these facilities do not meet the guidelines to be covered by Medicare and almost all insurance companies follow Medicare guidelines.

The insurance company I worked for used to deny claims for these facility services.

You  should be happy they told you upfront.  Some of these places don't and you get stuck with a bill you hadn't planned on paying.

There is no new law allowing them to charge this fee, but perhaps there is a law that they have to advise you of the fee beforehand 

You are wise in looking for a different facility to have the service done.  Does your DH's doctor have privileges to work at another Outpatient surgical center.... perhaps one that is affiliated with a hospital?

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This isn't true as  others in this thread have pointed out.  I am charged a facility fee for my doctor's visit in her office.       

[Lipstickdiva]

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@Carmie wrote:

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@Lipstickdiva wrote:

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@Lynnster67 wrote:

Also, if you are not officially admitted but are just "under observation" you get stuck w/big bill.  (This happened to my grandmother so I raised holy heck w/the insurance contact at my grandfather's former employer.)

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If you are in for under 24 hours and considered under observation, I know they charge for some things at a much higher rate.  We ran into this with my DH.  Initially he was in under observation and I was told to bring in any meds that he takes so they could give them to him because if they had to get them from the pharmacy, the price was ridiculously high.

As it turns out, he turned into a full admission and now our insurance company rejected the claim filed by the hospital, stating it wasn't medically necessary for him to be admitted. 

I was in the hospital about a year ago, under observation, and didn't pay a dime.

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If your hospital is in network with your insurance company and the admission was denied as not medically necessary, the hospital must "eat" the charges and can't bill you.

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Yes I know this.  But I have an issue with that because it was medically necessary and it's not fair for the hospital to not be paid.

I just got the official rejection with  the amount.  It's in excess of $54,000.00.  I called my insurance company today and they said the hospital has to be the one to appeal.  She said looking at what the charges were for, this will be covered as long as the  hospital appeals and submits back-up paperwork.