Re: New rip off - the facility fee - Page 7

Drythe · ‎07-09-2011

@151949 wrote:
My DH saw a GI doc and was scheduled to have a colonoscopy. To be done at an outpatient facility next door to the doctor's office. Colonscopies are covered 100% by our insurance as they are also by medicare. So today they call and confirm the appt., and tell him he will need to pay 20% copay for anything they remove will make this an outpatient surgery - OK we know about that AND he will be required to pay a $295 "facility fee". So DH calls the insurance company and wants to know what that is and why we have to pay it. Apparentl;y there is a law now that allows any facility doing procedures to charge you a fee - over & above your insurance - for the use of their facility. Even though this is an in network facility the insurance does not cover this "facility fee". They did tell him it is generally only about $20 - $25 and that $295 was pretty excessive. This isn't just our insurance - it is all insurances.The facility fee is a patient responsibility. DH is on the phone right now to try to find somewhere with a more reasonable or no facility fee, because I went ballistic when I heard almost $300 for this.

@151949

I'm sure you and Hubs are grateful for all your other blessings.

"Animals are not my whole world, but they have made my world whole" ~ Roger Caras

granddi · ‎03-16-2010

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.

Lila Belle · ‎01-24-2013

@151949 wrote:
My DH saw a GI doc and was scheduled to have a colonoscopy. To be done at an outpatient facility next door to the doctor's office. Colonscopies are covered 100% by our insurance as they are also by medicare. So today they call and confirm the appt., and tell him he will need to pay 20% copay for anything they remove will make this an outpatient surgery - OK we know about that AND he will be required to pay a $295 "facility fee". So DH calls the insurance company and wants to know what that is and why we have to pay it. Apparentl;y there is a law now that allows any facility doing procedures to charge you a fee - over & above your insurance - for the use of their facility. Even though this is an in network facility the insurance does not cover this "facility fee". They did tell him it is generally only about $20 - $25 and that $295 was pretty excessive. This isn't just our insurance - it is all insurances.The facility fee is a patient responsibility. DH is on the phone right now to try to find somewhere with a more reasonable or no facility fee, because I went ballistic when I heard almost $300 for this.

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Doesn't your Advantage policy pay for this?

If it doesn't and you knew it up front then why are you whining?

september · ‎03-09-2010

@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!

KarenQVC · ‎05-13-2010

@151949 If you do not owe this, the bill is attempted fraud. What if this were a really old person who had family or a management co. pay their bills and not check on small costs. The facility must pick up tons of bucks with this scheme against Advantage policies.

Carmie · ‎10-25-2010

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?

DiAnne · ‎09-22-2010

@september wrote:
@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!

@september

Then do they bill your insurance also? That does not sound ethical.

Carmie · ‎10-25-2010

@Burnsite wrote:
I don't know if this is FL related, but I have had ER visits, even though I have full insurance and the hospital is in the network, that cost me a lot of money out of pocket.

FL does not require ER doctors to agree to insurance for a year. I was in a facility that was insured, but its ER doctors are not necessarily insured. Florida.

Most ER doctors and other doctors as well do not work for the hospital. They bill seperately for their services and sometimes they are not in your insurance nertwork even though the hospital is.

If you get a bill for out of pocket expenses, WRITE a letter of appeal to the insurance company and tell them you had no choice in choosing your doctor and went to an in-net facility. These types of doctors are called ghost or phantom providers. Most insurance companies will pay your claim by exception up to 100% of the cost for you.

You must write your appeal letter in a timely manner and it helps to enclose the bill, you received. The address must be on the EOB that you receive from your insurance company.

september · ‎03-09-2010

@DiAnne wrote:
@september wrote:
@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!
@september

Then do they bill your insurance also? That does not sound ethical.

Yes, they bill our insurance for office visits. If we want to remain patients in the practice, we pay $450/quarter out of our own pockets. It's our choice, even though there is no longer much of a choice where I live. More and more physicians are going into this type of practice

Carmie · ‎10-25-2010

@Lipstickdiva wrote:
@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.)
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.

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.