Community Chat

[hyacinth003]

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@AngusandBuddhasMom wrote:

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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.

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We had the same experience when my husband had a colonoscopy and endoscopy also.  He chose the outpatient facility, thinking it was a less expensive option.  We wanted to be good citizens.  It ended up costing us WAY MORE out of pocket than had we chosen the hospital.  Not doing that again.

Hyacinth

[JaneMarple]

I've had both an endoscopy and colonoscopy at an outpatient facility on separate occasions, this facility is connected to the local hospital, no extra fees at either time.

[Carmie]

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@Lipstickdiva 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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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.       

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Well who is charging the facility fee?  The doctor?  

I know of no health insurance that will pay a facility fee billed by a doctor and I have never heard of a doctor charging for a facility fee for an office visit.

 If the doctor is in your insurance network, they cannot bill you a facility fee.  They must accept the insurance allowed amount. I have and always refuse to pay a doctor a bill for any services that they do not submit to my insurance first.

The EOB from my insurance will let me know if I owe anything or if the doctor must write off charges or if the charges are included in the office visit charge.

[Carmie]

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@Lipstickdiva wrote:

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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.   

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That is so nice of you to be concerned with the hospital getting paid.  My guess is that the hospital will rebill for observation, instead of inpatient and they will get paid.  It happens all of the time.

They could also also appeal the claim to be paid as an inpatient claim.  Most insurance companies require a precertification for an IP admission.  Sometimes the hospital doesn't call... their fault.  It will be difficult for them to get paid as a full admission, so an observation bill is more probable.

[granddi]

Medicare providers were GENEROUSLY PAID for converting patients to Electronic Health Records. They have also been paid for each "step" the doctor made in completing the change over to EHR including the computers. So don't pity the doctors or hospitals for the cost related to computerized records. 

If a Medicare provider does not comply within a certain time frame then the penalty is 1-2% withheld from payments. Docs had about 7 years to comply.

[VaBelle35]

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@Lynnster67 wrote:

If we only had Medicare for everyone as Bernie Sanders suggested (or nationalized healthcare like most of the rest of the Weseternized world), probably wouldn't have these issues.

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Correct.  We wouldn't have "these" issues.  We'd have different (and some would say bigger) issues.

[Marienkaefer2]

This is quite common to charge for this.

My number one priority would be the doctor.

If I trusted the doctor, I would go to the facility he does the procedures in.

You've already stated you have insurance that will cover the other expenses.

Is $300 really going to set you back so much?

There are many who do not have insurance who will cover all of the expenses associated with this procedure (I had to pay $1000 of it.)

Or, there are those who have no insurance to cover it, and therefore will not get this potentially life saving procedure.

Consider yourself fortunate that you are in a position to pay for the healthcare that you need.

[KarenQVC]

@Marienkaefer2 @151949  Most Medicare Advantage people want to pay as little as possible for health care.  That is why any doctor who charges extra fees should be dropped from their network.