With a lingering sinus infection she couldn’t shake, Kathleen Smith went to an urgent care center in Manchester before work.
She paid $100 to see a doctor at Elliot Urgent Care at River’s Edge about a year and a half ago, but Smith got hit with another $100 bill in the mail. She thought it was a mistake, a double charge.
Nope, a billing company confirmed it as a “facility fee.”
A facility fee is often applied by medical offices, urgent care centers and clinics affiliated with hospitals to spread costs across the network to boost revenue to offset losses. The fees are legal, but many say they’re poorly disclosed and carry a high cost compared to the services provided.
“All I did was walk into urgent care in the morning, and all of a sudden I am paying an additional $100,” Smith said.
Smith, who lives in Manchester, checked to make sure Elliot accepted her insurance before going. They did.
“The reason I went there is because I still wanted to go to work, and they open at 7 a.m.,” she said. “They were the earliest one to open up.”
These fees have been around for decades, and government agencies and consumer groups continue to fight against the charges — or push to make them more transparent for the patient.
Facility fees have become more frequent as the number of physicians affiliated with hospitals or larger health care networks have increased over the past 20 years, according to Tyler Brannen, director of health economics with the New Hampshire Insurance Department.
“It’s definitely seen as a way to maximize revenue,” he said.
There’s also been an increase in urgent care centers to reduce pressure on hospital emergency rooms.
As a way to inform patients about health care costs, the state launched NH HealthCost to improve the price transparency of health care services and help patients find the best option.
“People don’t know when they go to a hospital site that’s not on the hospital campus they are going to get these two bills, the facility bill and the professional fee,” he said.
Elliot Health System declined comment on the specifics of its facility fees like the one that caught Smith off guard.
“Elliot Health System offers the community steady access to specialty trained board certified emergency medicine physicians who are backed by a robust level of onsite diagnostic capabilities,” said Tate Curti, chief operating officer of Elliot Health System, in a statement.
Nearby Express Med does not have a facility fee as an independent provider.
“If you come into one of our facilities for a normal urgent care visit, you get one bill,” said Nicole Lane, director of marketing. Costs for specialized services can fluctuate.
“We’re trying to give people more choice, to give people more information and to be as transparent as possible,” Lane said.
Dartmouth-Hitchcock does not operate its own urgent care center, and Catholic Medical Center does not charge a facility fee.
Fighting the charge
Smith fought Elliot’s facility charge by sending a letter to CEO Doug Dean and filing a complaint with the state Insurance Department.
“I just went right to the top,” she said. “I said, ‘This is baloney,’ I knew it was baloney.”
The fee ended up being waived.
However, the fees are historically tough for patients to fight, especially through a third-party collection agency, according to the Insurance Department.
“You walk in the door and usually sign your life away,” Brannen said. “It is a tough place to be.”
In 2009 and 2010, a legislative commission studied the billing practices of health care providers, including facility fees.
“Testimony provided to the commission indicated that the prices for hospital services are not a function of their actual direct cost, but reflect the additional and growing costs of owning and operating physician networks as well as the cost of providing services to Medicare and Medicaid patients along with charity care,” the report reads.
Hospitals fought against changes to the regulations, Brannen said.
Steve Ahnen, president of the New Hampshire Hospital Association, said hospitals and their affiliated facilities have higher cost structures because of emergency stand-by capacity and increased costs of regulations imposed on them.
“With more comprehensive licensing, accreditation and regulatory requirements, hospital-affiliated facilities must comply with a much more comprehensive scope of licensing, accreditation and other regulatory requirements than do free-standing physician offices,” Ahnen said.
Hospital facilities provide critical services that are “not otherwise available in the community and treat higher-severity patients,” he said.
What to know?
Some insurance companies are working to reimburse more for the facilities fees to reduce the cost for patients, but the fees still exist, Brannen said. NH HealthCost recommends customers call ahead of a visit and ask about copays and charges.
“You need to ask ahead of time,” Brannen said.
Express Med can typically tell patients the cost of care based on their needs and insurance provider.
“If folks are looking for an inexpensive, cost-transparent, high-quality option they should seek out independent providers when at all possible,” Lane said.
Smith thinks it’s important for patients to understand the hidden fee.
“I think it is a bogus way for them to make an extra $100,” she said. “I think that because nobody has brought it up before that they’ve been getting away with it.”