Credit: Photo courtesy of and copyright Vintage Stock Photos, www.vintagestockphotos.com
Did that get your attention?
Read on and it’ll make sense in a minute.
The Kaiser Family Foundation recently published a story “The Charges Seem Crazy”[i] about a trick that hospitals are using to extract more money from patients, it’s called a “Facility Fee”. It’s legal, but reeks and based on other industries, I think they may have to change how they do it.
When I read the article, three things struck me but first, let me recap the story in case you haven’t seen it yet. While some insurance carriers may provide “free” teleheath visits for consultations where you don’t physically “go to the doctor”, the doctor sometimes bills you directly. This makes perfect sense if you think about it. Pre-pandemic, you would make an appointment and go see your doctor. They would bill you for an “office visit.” Duh! The doctor’s office needs to get paid. Now that it’s more common (and legal prohibitions have been somewhat relaxed) you don’t always have to physically “go” to the doctor, they can just video-chat. But they still need to get paid.
The first thing that struck me was the hospital sent her (Arielle Harrison) a notice, IN ADVANCE, that she would not only be billed the regular rate for a doctor’s visit, but that there would ALSO be a bill for the facility. The hospital sort of said “look, we know you’re not coming in, but we still have to maintain the building and keep the lights on, so pay us!”
The second thing that I questioned was “How were you keeping the lights on before?” Traditionally, the cost of the doctor’s office, staff, electricity, tongue-depressors, etc., was all accounted for in the “Office Visit”. Now, they want to keep the office visit price the same, but still generate significant additional revenue.
Enter the “Facility Fee”.
Hasn’t this been tried in other industries?
The hotel industry has been running this scam for years, but recently been losing lawsuits for deceptive billing practices. In the hotel-biz, they use terms like “Resort Fee” or “Spa Fee” and tell you it covers the use of the pool or the tennis courts or towels at the beach. You might say “Well, I’m on a business trip and I won’t need the pool or beach, so please remove that fee.” Sorry, it’s actually NOT optional and they just do it because they know you booked the room believing the price was one thing (the price they advertised) and now that you’re standing in the Check-in line, it’s too late sucker! Hotels should charge whatever they want/can, but the deception isn’t allowable. Marriott is among the first to STOP this deceptive practice, although their conscience didn’t develop until after a number of State Attorney Generals intervened[ii].
And lastly, the article flat-out states “Facility fees for video appointments remain rare.” So, I dug into that and easily disproved it. The charges MAY be currently rare in commercial / self-pay, but they are specifically provided for under CMS rules for Medicare patients[iii] and since Medicare covers millions of elderly Americans, you can rest assured that the government (taxpayers) is picking-up the tab, just behind the scenes where nobody is shining a light on the practice.
Telehealth in the US was quite uncommon before the pandemic. The biggest “payer”, the US government, didn’t allow it. If a doctor decided to provide services anyway, even to commercial patients, they put their practice and license at risk of malpractice claims because they might miss something or violate some HIPAA privacy guideline. All risk, no return? No way!
But now it seems obvious that you and your doctor should be able to “chat” about many issues (and the doctor should be paid for their knowledge and advice). If the doctor still has their own practice, they should be charging enough money to continue practicing medicine and that includes paying their rent and the salaries of their nurses and staff. If the doctor is merely an employee of a hospital (or other “facility”) then they should do the same. But charging ADDITIONAL fees for services like “keeping the lights on in the hospital” is just like hotels charging a “resort fee.” They’re gaming the system by trying to keep their “visit” charges in-line with competitors (and what the insurance carriers will reimburse) while sneaking thru yet another fee.
[i] ‘The Charges Seem Crazy’: Hospitals Impose a ‘Facility Fee’ — For a Video Visit, December 17, 2021 https://khn.org/news/article/telemedicine-hospital-facility-fees-video-visit/
[ii] Marriott agrees to include resort fees in upfront pricing after reaching settlement with Pennsylvania AG https://www.usatoday.com/story/travel/hotels/2021/11/19/marriott-resort-fees-upfront-pricing-pennsylvania-ag/8691311002/
[iii] CMS Rules on Telehealth Services frequency and billing. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf