Hitting the Headlines, Surprise & Confusion, Not a Drop, & Surprisingly So

Say What?

Imagine you just moved to Surprise City, AZ (yes, it’s a real place) and are spending Friday evening searching the internet for a primary care physician (PCP). Up pops the Surprise City Medical’s (SCM) website and it sounds perfect! It’s close by, offers Saturday appointments and the building looks quite new. Best of all, SCM accepts your insurance and provides a full range of primary care services. Perfect! Well, perfect until you receive SCM’s bill for your visit.

SCM’s bill is for $100. How can this be you ask yourself? Surely it must be an error because your office visit copay is $20 and the deductible was met earlier in the year. Why is there an $80 facility charge in addition to the $20 copay? You went to a doctor’s office, not a facility like a hospital.

The next day you call SCM’s billing department to discuss the apparent error and ask them to remove the facility charge. It is then you learn that just because something looks like a doctor’s office and is advertised as a doctor’s office is not really a doctor’s office visit – at least when it comes to billing. SCM, like many physician practices and clinics, is owned by a hospital – and thus a facility fee is added to the office and clinic bills to “offset the extra costs of maintaining the facility (hospital).”

As hospital ownership of physician practices and clinics becomes more common, so are facility charges. Patients are often completely unaware that the physician that they have seen for years at the same location is owned by a hospital – until they get the bill with a the facility charge.

Today, President Biden announced new guidance on the No Surprises Act that targets the “facility fee” loophole. While this guidance does not ban charging facility fees by hospital-owned medical practices and clinics, it requires health plans and providers to publicly disclose facility fees  – an important step forward!

Happy Reading!

Suzanne Daniels