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Anyone have any experience with a charge for a "facilities" fee in connection with an annual dermatology exam?    

Background:  I have a PPO insurance plan  GP recommended that I should have an annual exam by a dermatologist due to a past skin cancer (removed a few years ago).  So I looked on my insurer's website to select a doctor who was in network and made an appointment.

A few hospitals in my location (Los Angeles County) have recently been buying up medical groups, and the medical group with whom I made the appointment is apparently now affiliated with a hospital.  I subsequently noticed on YELP that people were complaining about an undisclosed facilities fee being charged for a visit to this doctor so I inquired whether there would be a facilities fee in connection with my upcoming office visit.   The appointment desk said that a facility fee would apply but she said she couldn't tell me what that fee would amount to.

ETA:  I just web-searched "facilities fee" and this article, "This increasingly common hidden fee is a nasty surprise on medical bills"  showed up on Market Watch's website.  Here's the link to the article:  Market Watch 
Hopefully the advanced heads up might help someone else here on FW.

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With my insurance plan ( state employee BCBS PPO ) everything done on the same date is counted as one visit and part of ... (more)

Paragon (Sep. 01, 2017 @ 1:45p) |

Do you honestly think that it is the insurance company paying doctors and not the people paying premiums?

JepJepJep (Sep. 01, 2017 @ 2:09p) |

OP doesn't care that the taxpayers are taking the hit.

stanolshefski (Sep. 04, 2017 @ 7:34a) |

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Ask them if the fee will still be assessed if you don't take a dump during your visit.

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Yes, people have complained about these fees for a long time. Lab draws in particular are terrible since it makes the cost much higher in comparison to a commercial lab (such as Quest). The problem is that this sort of fee is completely hidden until you get your bill. Generally the doctors, nurses, and office staff have no idea what these fees are since they are back end.

You can do your due diligence, but there is almost no way to avoid getting charged for things out of your control, and that is one of the fundamental problems of the current healthcare system. At times, choice in healthcare is a fallacy.

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BNizzle said:   Yes, people have complained about these fees for a long time. Lab draws in particular are terrible since it makes the cost much higher in comparison to a commercial lab (such as Quest). The problem is that this sort of fee is completely hidden until you get your bill. Generally the doctors, nurses, and office staff have no idea what these fees are since they are back end.

You can do your due diligence, but there is almost no way to avoid getting charged for things out of your control, and that is one of the fundamental problems of the current healthcare system. At times, choice in healthcare is a fallacy.

  Thanks for the heads up about the lab draws.  I wasn't aware of that issue so I'll be sure to request a commercial lab if I need tests.

Regarding disclosing  facilities fees, It seems to me that if a medical group is acquired by a hospital, that the hospital knows and should make the medical group aware of the facility fee they are going to charge the patient for the use of a single examining room in the doctor's office.  Attorneys in California provide an estimate of their hourly billing rate and don't bill separately for the room they use during that initial consultation.  If I go to the dentist, he doesn't charge me extra for providing a chair.  

 

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bighitter said:   
BNizzle said:   Yes, people have complained about these fees for a long time. Lab draws in particular are terrible since it makes the cost much higher in comparison to a commercial lab (such as Quest). The problem is that this sort of fee is completely hidden until you get your bill. Generally the doctors, nurses, and office staff have no idea what these fees are since they are back end.

You can do your due diligence, but there is almost no way to avoid getting charged for things out of your control, and that is one of the fundamental problems of the current healthcare system. At times, choice in healthcare is a fallacy.

  Thanks for the heads up about the lab draws.  I wasn't aware of that issue so I'll be sure to request a commercial lab if I need tests.

Regarding disclosing  facilities fees, It seems to me that if a medical group is acquired by a hospital, that the hospital knows and should make the medical group aware of the facility fee they are going to charge the patient for the use of a single examining room in the doctor's office.  Attorneys in California provide an estimate of their hourly billing rate and don't bill separately for the room they use during that initial consultation.  If I go to the dentist, he doesn't charge me extra for providing a chair.  

 

  I'm starting to feel like I should strip down in the waiting room, or tell the dentist "no thank you, I'll stand" when they tell me to sit in the chair.

I'm fairly inexperienced in medical insurance issues (knock on wood).  I also have PPO.  Doesn't the insurance plan dictate what charges are allowable per treatment, and what those charges can be?  Wouldn't a facilities fee typically be considered not allowable and therefore inapplicable for those with insurance?
 

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MD here, but certainly not my area of expertise. I wouldn't use lawyers as the posterchild of clear billing... It (buying up practices by hospitals) is a trend with problems. Sometimes they buy them up just to assure a continued referral basis, but othertimes they buy them up know that they can bill higher than the office can independantly. This also can have the Nasty consequence of insurance not covering things like you'd expect. I'd be careful going to any practice owned or affiliated with a hospital for that reason. Once the hopsitla owns the practice, think more like 'ER visit' than 'outpatient $20 copay'. Not exactly, but there is a grey zone. Sorry, it sucks.

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My displeasure is my clinic ALWAYS codes my FREE annual exam as a normal visit and collects a copay. They also insist on labs to protect their ass and bill me anything not covered by insurance.

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My wife recently had a series of shots done to her back. Four shots in one visit. They charged four separate "facility" fees on the bill. One for each shot, even though they were all done at the same time in the same place. Insurance of course knocked the fees down from about $2500 to about $1300 each, then applied toward deductible, then the 20% copay. So we didn't end up paying the whole amount, luckily. But in my opinion, the Doctor's Office definitely took the insurance company to the cleaners on this one.

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2500 per shot as a facilities fees (ie $10,000) - wow! This needs to get some press. Until someone in the press picks it up, no one will pay attention.

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this is an untended consequence of ACA. Part of trying to get every doctor office's on electronic medical records was them entering to agreements (affiliate, CIN, etc) with hospitals, who were already electronic. Or being completely bought out by the hospital. A way of recouping the cost is to now charge facility fees when you visit the doctor. It is part of the price we all pay to drive data back to analytic systems to help eradicate disease as well improve your care across facilities.

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There should be law that charges should be made aware of before any procedures are done. Not for emergency procedures.

Also antitrust law against hospitals buying more than 5% offices in your area unless it is underserved area.


Half of the procedures are not done and the insurance is billed for by the hospitals and clinics.
They should make it compulsory for doctors only to do the billing and not some manager.

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from the market watch article:
Hospitals, in return, say these charges are key to their business model
why should i subsidize your "business model"? if i say my "business model" is to receive all medical care (including elective services) 100% free, do hospitals and medical offices have to accommodate me because it's my "business model"?
 

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It also pushes people to the ER. With my insurance, as long as you aren't admitted to the hospital, your entire ER visit is always one price. Sure, it's expensive, but the times I've done it I settle my co-pay afterward treatment and don't ever get a bill.

No unexpected bills. No arguing billing codes. No in network vs out of network. No hidden fees. Is it a little more money? Probably, but I'm just trading cash for fast service and convenience. I bet my insurance pays out the rear end, however.

Is that bad for the system as a whole? Maybe, but the system is broken so I don't feel bad about breaking it a little more.

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Our ER and Urgent care all have a facility fee. Almost all the in network doctors are part of that medical group. It's been that way for years, so I'm used to seeing the facility fee as a separate bill from any doctor, visit, and lab bills I get.
Going to the ER doesn't make things any better, I still wind up with at least four bills for a visit, they're just higher cost.

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tante said:   this is an untended consequence of ACA. Part of trying to get every doctor office's on electronic medical records was them entering to agreements (affiliate, CIN, etc) with hospitals, who were already electronic. Or being completely bought out by the hospital. A way of recouping the cost is to now charge facility fees when you visit the doctor. It is part of the price we all pay to drive data back to analytic systems to help eradicate disease as well improve your care across facilities.
 

  "...the result of an obscure change in Medicare rules that occurred nearly a decade ago.Called “provider-based billing,” it allows hospitals that own physician practices and outpatient clinics that meet certain federal requirements to bill separately for the facility as well as for physician services. Because hospitals that bill Medicare beneficiaries this way must do so for all other patients, facility fees affect patients of all ages. Doctors’ offices owned by physicians and freestanding clinics are not permitted to charge them..."
http://khn.org/news/fees/

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JW10 said:   My displeasure is my clinic ALWAYS codes my FREE annual exam as a normal visit and collects a copay. They also insist on labs to protect their ass and bill me anything not covered by insurance.
  
I actually changed doctors over this exact thing. Vote with your wallet (if you can). I actually contacted the physician directly and he lamented that he didn't want to lose a patient over how his (group mandated) back office does the billing, but he understood my position.

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This is going to continue for the near future. As some have alluded to, its part of the "plan" with hospitals buying practices and its completely legal at this time. I could possibly understand the need for this if it was something like 5 bucks extra but at the charges I typically see, its hard to see how the facility fee is improving patient care. I'm hoping our practice remains independent.

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svap said:   
  "...the result of an obscure change in Medicare rules that occurred nearly a decade ago.Called “provider-based billing,” it allows hospitals that own physician practices and outpatient clinics that meet certain federal requirements to bill separately for the facility as well as for physician services. Because hospitals that bill Medicare beneficiaries this way must do so for all other patients, facility fees affect patients of all ages. Doctors’ offices owned by physicians and freestanding clinics are not permitted to charge them..."
http://khn.org/news/fees/

I wonder if there have been changes to the rules since khn.org's 2009 article that you linked.  The dermatologist's office that I mentioned in the original post is not in a hospital. The office is in a regular high-rise office building with numerous tenants.  On second thought, perhaps the hospital is allowed to identify a suite of offices in a building as an outpatient clinic.

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tante said:   this is an untended consequence of ACA. Part of trying to get every doctor office's on electronic medical records was them entering to agreements (affiliate, CIN, etc) with hospitals, who were already electronic. Or being completely bought out by the hospital. A way of recouping the cost is to now charge facility fees when you visit the doctor. It is part of the price we all pay to drive data back to analytic systems to help eradicate disease as well improve your care across facilities.
  You are doing 2+2=44 here. There is nothing wrong going all electronic. What we are talking here is systemic abuse.

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delhel said:   
tante said:   this is an untended consequence of ACA. Part of trying to get every doctor office's on electronic medical records was them entering to agreements (affiliate, CIN, etc) with hospitals, who were already electronic. Or being completely bought out by the hospital. A way of recouping the cost is to now charge facility fees when you visit the doctor. It is part of the price we all pay to drive data back to analytic systems to help eradicate disease as well improve your care across facilities.
  You are doing 2+2=44 here. There is nothing wrong going all electronic. What we are talking here is systemic abuse.

  while I don't speak for that individual, I believe what he/she was implying is that small doctors offices have a hard time implementing EMRs.  They are very costly and frequently wont communicate with the one the hospital uses and unfortunately it isn't uncommon for the service to go under or no longer update or whatever as that market changes even though you have sunk 100k into it.  Single providers cant handle those costs.  To improve patient care, there are "incentives" to get us all on the same sort of EMR at least locally.

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wp746911 said:   MD here, but certainly not my area of expertise. I wouldn't use lawyers as the posterchild of clear billing... It (buying up practices by hospitals) is a trend with problems. Sometimes they buy them up just to assure a continued referral basis, but othertimes they buy them up know that they can bill higher than the office can independantly. This also can have the Nasty consequence of insurance not covering things like you'd expect. I'd be careful going to any practice owned or affiliated with a hospital for that reason. Once the hopsitla owns the practice, think more like 'ER visit' than 'outpatient $20 copay'. Not exactly, but there is a grey zone. Sorry, it sucks.
Perhaps most lawyers aren't poster children of clear billing, but they are orders of magnitude better than doctors/hospitals. Even if we could get doctors to be merely as good as attorneys, we'd be much better off than we are now.

It would never ever ever fly for me to randomly bill legal clients whatever trumped-up amounts I concocted with no prior notice or authorization. I don't know how the health care system gets away with it. It should be criminal. I know I'd be disbarred for doing half this crap.

(I may be in the minority, but I do flat-rate billing disclosed in writing in advance. I don't up-charge clients for add-ons even when it's justified. I just don't ever want a client surprised by a bill.)

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AlwaysWrite said:   
wp746911 said:   MD here, but certainly not my area of expertise. I wouldn't use lawyers as the posterchild of clear billing... It (buying up practices by hospitals) is a trend with problems. Sometimes they buy them up just to assure a continued referral basis, but othertimes they buy them up know that they can bill higher than the office can independantly. This also can have the Nasty consequence of insurance not covering things like you'd expect. I'd be careful going to any practice owned or affiliated with a hospital for that reason. Once the hopsitla owns the practice, think more like 'ER visit' than 'outpatient $20 copay'. Not exactly, but there is a grey zone. Sorry, it sucks.
Perhaps most lawyers aren't poster children of clear billing, but they are orders of magnitude better than doctors/hospitals. Even if we could get doctors to be merely as good as attorneys, we'd be much better off than we are now.

It would never ever ever fly for me to randomly bill legal clients whatever trumped-up amounts I concocted with no prior notice or authorization. I don't know how the health care system gets away with it. It should be criminal. I know I'd be disbarred for doing half this crap.

(I may be in the minority, but I do flat-rate billing disclosed in writing in advance. I don't up-charge clients for add-ons even when it's justified. I just don't ever want a client surprised by a bill.)

  Maybe because lawyers do not have 140,000 codes used to describe diseases and hospital procedures in the insurance billing process

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AlwaysWrite said:   Perhaps most lawyers aren't poster children of clear billing, but they are orders of magnitude better than doctors/hospitals. Even if we could get doctors to be merely as good as attorneys, we'd be much better off than we are now.

It would never ever ever fly for me to randomly bill legal clients whatever trumped-up amounts I concocted with no prior notice or authorization. I don't know how the health care system gets away with it. It should be criminal. I know I'd be disbarred for doing half this crap.

(I may be in the minority, but I do flat-rate billing disclosed in writing in advance. I don't up-charge clients for add-ons even when it's justified. I just don't ever want a client surprised by a bill.)

Oh I see.  So as a lawyer, you deal with and contract with 100's of legal insurance companies?  You understand intrinsically how each of your clients' legal insurance works?  You code your legal work in tens of thousands of different "codes" to use for billing?  You must share in the cost of all the other lawyers that work probono or are public defenders?  If you work for a larger company, there is a federal mandate that you take on every single client regardless of ability to pay until their legal problem is "stable"?  
Oh...you don't.  You just have a simple agreement with your client, and if they can't pay, then you don't do the work?  Oh it's that simple?  

I'm the 1st to say the medical billing system is messed up.  However, it is so inherently complex that despite knowing how it works, put me in charge and I would still have no idea how to fix it.  

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bighitter said:   
svap said:   
  "...the result of an obscure change in Medicare rules that occurred nearly a decade ago.Called “provider-based billing,” it allows hospitals that own physician practices and outpatient clinics that meet certain federal requirements to bill separately for the facility as well as for physician services. Because hospitals that bill Medicare beneficiaries this way must do so for all other patients, facility fees affect patients of all ages. Doctors’ offices owned by physicians and freestanding clinics are not permitted to charge them..."
http://khn.org/news/fees/

I wonder if there have been changes to the rules since khn.org's 2009 article that you linked.  The dermatologist's office that I mentioned in the original post is not in a hospital. The office is in a regular high-rise office building with numerous tenants.  On second thought, perhaps the hospital is allowed to identify a suite of offices in a building as an outpatient clinic.

  I think it is base on "provider-base status". Maybe somebody can translate this http://www.law.cornell.edu/cfr/text/42/413.65

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Chill99 said:   
AlwaysWrite said:   Perhaps most lawyers aren't poster children of clear billing, but they are orders of magnitude better than doctors/hospitals. Even if we could get doctors to be merely as good as attorneys, we'd be much better off than we are now.

It would never ever ever fly for me to randomly bill legal clients whatever trumped-up amounts I concocted with no prior notice or authorization. I don't know how the health care system gets away with it. It should be criminal. I know I'd be disbarred for doing half this crap.

(I may be in the minority, but I do flat-rate billing disclosed in writing in advance. I don't up-charge clients for add-ons even when it's justified. I just don't ever want a client surprised by a bill.)

Oh I see.  So as a lawyer, you deal with and contract with 100's of legal insurance companies?  You understand intrinsically how each of your clients' legal insurance works?  You code your legal work in tens of thousands of different "codes" to use for billing?  You must share in the cost of all the other lawyers that work probono or are public defenders?  If you work for a larger company, there is a federal mandate that you take on every single client regardless of ability to pay until their legal problem is "stable"?  
Oh...you don't.  You just have a simple agreement with your client, and if they can't pay, then you don't do the work?  Oh it's that simple?  

I'm the 1st to say the medical billing system is messed up.  However, it is so inherently complex that despite knowing how it works, put me in charge and I would still have no idea how to fix it.  

There are plenty of legal insurance companies that lawyers deal with all the time. They still have to provide clear, detailed bills, broken down to .1 or .2 hours, at a pre-approved hourly rate. I wish we had codes to make some of this easier, but instead we have to spell out in writing exactly what we did each hour for each client every single day. And the clients generally know what they are responsible for paying, and what the insurance company will pay. (I'm not an expert on legal insurance billing, but I doubt lawyers get to balance bill the client for whatever the insurer says is "out of network" or not covered.)

As far as taking on clients until they are stable, you are only talking about ERs at hospitals, right? Not your average doctor's office? (I certainly agree the "accept anyone at an ER" but also "try to apply free market principles" are contradictory and lead to many problems.)

What does that mean that doctors "share in the cost of other lawyers that work pro bono or are public defenders." Are you talking about the ER issue above? Do you somehow have to "share in the cost" for doctors working for the government at a VA hospital or something?

Do you really deal with "100's of insurance companies"? I have 4 choices of companies in marketplace plans, and that's in a major metro area in FL. (I could only find a list of 12 companies authorized to operate in FL.) Most doctors seem to take 1 or 2 of the 4. The problem is, doctors can't even tell you the amount they will BILL the insurance company (I get if they're not 100% sure of deductibles & such), because some make up essentially random numbers hoping to get lucky on a few high reimbursements or nailing uninsured patients, and in other cases accept 20% or 50% of the randomly-billed amount. That is a common billing practice, it's not the insurance companies or patients making doctors do that.

Even when I pre-pay in cash at a doctor's office, I often end up getting a bill in the mail for double the agreed-upon price. I guess they just hope some percentage of people don't notice and pay twice? That's fraud. Happens to me all the time at doctors. But I've never once billed a client again for something they already paid.

Listen, I'm not trying to blame all of these on you, and I do understand the medical billing system is complex, and that I don't know enough about it to fully fix it either. But I also know even from my limited personal experience that it is difficult or impossible to ever figure out how much a medical visit will cost before it's done, and that is simply not a fair system. It's ripe for abuse, and many doctors take advantage.

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If you have a PPO, with a set fee per visit, simply refuse to pay.

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AlwaysWrite said:   
Chill99 said:   
AlwaysWrite said:   Perhaps most lawyers aren't poster children of clear billing, but they are orders of magnitude better than doctors/hospitals. Even if we could get doctors to be merely as good as attorneys, we'd be much better off than we are now.

It would never ever ever fly for me to randomly bill legal clients whatever trumped-up amounts I concocted with no prior notice or authorization. I don't know how the health care system gets away with it. It should be criminal. I know I'd be disbarred for doing half this crap.

(I may be in the minority, but I do flat-rate billing disclosed in writing in advance. I don't up-charge clients for add-ons even when it's justified. I just don't ever want a client surprised by a bill.)

Oh I see.  So as a lawyer, you deal with and contract with 100's of legal insurance companies?  You understand intrinsically how each of your clients' legal insurance works?  You code your legal work in tens of thousands of different "codes" to use for billing?  You must share in the cost of all the other lawyers that work probono or are public defenders?  If you work for a larger company, there is a federal mandate that you take on every single client regardless of ability to pay until their legal problem is "stable"?  
Oh...you don't.  You just have a simple agreement with your client, and if they can't pay, then you don't do the work?  Oh it's that simple?  

I'm the 1st to say the medical billing system is messed up.  However, it is so inherently complex that despite knowing how it works, put me in charge and I would still have no idea how to fix it.  

There are plenty of legal insurance companies that lawyers deal with all the time. They still have to provide clear, detailed bills, broken down to .1 or .2 hours, at a pre-approved hourly rate. I wish we had codes to make some of this easier, but instead we have to spell out in writing exactly what we did each hour for each client every single day. And the clients generally know what they are responsible for paying, and what the insurance company will pay. (I'm not an expert on legal insurance billing, but I doubt lawyers get to balance bill the client for whatever the insurer says is "out of network" or not covered.)

As far as taking on clients until they are stable, you are only talking about ERs at hospitals, right? Not your average doctor's office? (I certainly agree the "accept anyone at an ER" but also "try to apply free market principles" are contradictory and lead to many problems.)

What does that mean that doctors "share in the cost of other lawyers that work pro bono or are public defenders." Are you talking about the ER issue above? Do you somehow have to "share in the cost" for doctors working for the government at a VA hospital or something?

Do you really deal with "100's of insurance companies"? I have 4 choices of companies in marketplace plans, and that's in a major metro area in FL. (I could only find a list of 12 companies authorized to operate in FL.) Most doctors seem to take 1 or 2 of the 4. The problem is, doctors can't even tell you the amount they will BILL the insurance company (I get if they're not 100% sure of deductibles & such), because some make up essentially random numbers hoping to get lucky on a few high reimbursements or nailing uninsured patients, and in other cases accept 20% or 50% of the randomly-billed amount. That is a common billing practice, it's not the insurance companies or patients making doctors do that.

Even when I pre-pay in cash at a doctor's office, I often end up getting a bill in the mail for double the agreed-upon price. I guess they just hope some percentage of people don't notice and pay twice? That's fraud. Happens to me all the time at doctors. But I've never once billed a client again for something they already paid.

Listen, I'm not trying to blame all of these on you, and I do understand the medical billing system is complex, and that I don't know enough about it to fully fix it either. But I also know even from my limited personal experience that it is difficult or impossible to ever figure out how much a medical visit will cost before it's done, and that is simply not a fair system. It's ripe for abuse, and many doctors take advantage.

  And then, after you pay the ridiculous bill that they failed to mention prior to treatment, they send you letters monthly asking for donations. Imagine if, as a lawyer's client, after the lawyer billed you for $15k when the budget was $10k and you made it clear you were upset but paid anyway, they asked you for a donation so that they could "continue to provide top quality [service] to other[s]..."

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tante said:   this is an untended consequence of ACA. Part of trying to get every doctor office's on electronic medical records was them entering to agreements (affiliate, CIN, etc) with hospitals, who were already electronic. Or being completely bought out by the hospital. A way of recouping the cost is to now charge facility fees when you visit the doctor. It is part of the price we all pay to drive data back to analytic systems to help eradicate disease as well improve your care across facilities.
  
Facility fees have around longer than the ACA has. When my son (now 22) was a few months old, he need orthopedic visits and treatment. We were charged facility fees when we saw the Dr in the hospital outpatient clinic, but not in his other office.

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svap said:   
tante said:   this is an untended consequence of ACA. Part of trying to get every doctor office's on electronic medical records was them entering to agreements (affiliate, CIN, etc) with hospitals, who were already electronic. Or being completely bought out by the hospital. A way of recouping the cost is to now charge facility fees when you visit the doctor. It is part of the price we all pay to drive data back to analytic systems to help eradicate disease as well improve your care across facilities.
  "...the result of an obscure change in Medicare rules that occurred nearly a decade ago.Called “provider-based billing,” it allows hospitals that own physician practices and outpatient clinics that meet certain federal requirements to bill separately for the facility as well as for physician services. Because hospitals that bill Medicare beneficiaries this way must do so for all other patients, facility fees affect patients of all ages. Doctors’ offices owned by physicians and freestanding clinics are not permitted to charge them..."
http://khn.org/news/fees/

  Another federal government goal is to have as many physicians as possible to be employed by hospitals. Then the government officials can coerce physicians by coercing hospitals. The plan was a sneaky trap by paying hospital employed physicians 50% on average more than physicians in private practice. The unintended consequence is that the Medicare and patients will pay more. Many hospitals are losing money because the hospital owned medical practices are much less efficient. For the government officials, they are willing to do what it takes to avoid herding independent physicians as they are as obstinate as herding cats.

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Some interesting information and perspective from "Medical Economics" website, which apparently is a medical trade publication.  Their article  "New facility fees rule could slow practice acquisitions" link Medical Economics website article here   "Under a rule that took effect January 1, Medicare is reducing its payments for services and procedures at many hospital-owned outpatient departments, bringing them closer to what it pays physicians in independent practice for the same services and procedures.  The new rule reduces facility fee payments by 50%. However, it applies only to outpatient facilities not on a hospital’s main campus ...Several things give hospitals the appetite to acquire independent facilities, but one of the most important is the opportunity to charge more for the same service,” says Marni Jameson Carey, executive director of the Association of Independent Doctors. “And it drives up [healthcare] costs astronomically.” 

Unless I'm missing something, it appears this new rule applies only to Medicare so probably won't help the rest of us who have private or Obamacare insurance.

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Insurers will soon follow what medicare pays, so this income stream may be reduced in the coming years.  However, hospitals will always find something else to charge for.  There is no stopping healthcare inflation because it is driven by executives and shareholders.  To them, healthcare is no different than computer hardware or clothing.

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BNizzle said:   Insurers will soon follow what medicare pays, so this income stream may be reduced in the coming years.  However, hospitals will always find something else to charge for.  There is no stopping healthcare inflation because it is driven by executives and shareholders.  To them, healthcare is no different than computer hardware or clothing.
  The difference is most health care is paid by someone else ie the government or insurance company. Whereas, we the consumer are not willing to part with our cash easily.

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rpi1967 said:   
BNizzle said:   Insurers will soon follow what medicare pays, so this income stream may be reduced in the coming years.  However, hospitals will always find something else to charge for.  There is no stopping healthcare inflation because it is driven by executives and shareholders.  To them, healthcare is no different than computer hardware or clothing.
  The difference is most health care is paid by someone else ie the government or insurance company. Whereas, we the consumer are not willing to part with our cash easily.

That's how this system was allowed to get so out of control. There's a middleman in between (the insurance company), so people didn't realize (or care) what they were actually paying for things. There was incentive to use as much as you can, sure go ahead and do that test if you want doc, OK fine charge some new random facility fee, creatively up-charge this visit to some more expensive code, etc. when your monthly premium is the same. (The rise of high-deductible plans is very slowly starting to change that behavior, and make people feel the pain, whereas before it was hidden and rolled into their monthly insurance premiums.)

On top of that, most people also have (or at least had) the insurance premiums paid by their employers, so they didn't even see the indirect effects of premiums rising. So there was a 2nd level of middlemen in between shielding the consumers from actual prices. What people may have noticed is that salaries generally stopped increasing, and one reason for that is that employers had to Dish out an additional 5-10% a year just to maintain the same level of health care coverage, so basically that's where a lot of people's raises went.

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I love how healthcare is one of the few professions where it's okay to not tell you what the service will cost and then send you an outlandish bill with no justification for each fee.

Any other service industry would end up being destroyed if that were the case.

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AlwaysWrite said:   There are plenty of legal insurance companies that lawyers deal with all the time. They still have to provide clear, detailed bills, broken down to .1 or .2 hours, at a pre-approved hourly rate. I wish we had codes to make some of this easier, but instead we have to spell out in writing exactly what we did each hour for each client every single day. And the clients generally know what they are responsible for paying, and what the insurance company will pay. (I'm not an expert on legal insurance billing, but I doubt lawyers get to balance bill the client for whatever the insurer says is "out of network" or not covered.)

As far as taking on clients until they are stable, you are only talking about ERs at hospitals, right? Not your average doctor's office? (I certainly agree the "accept anyone at an ER" but also "try to apply free market principles" are contradictory and lead to many problems.)

What does that mean that doctors "share in the cost of other lawyers that work pro bono or are public defenders." Are you talking about the ER issue above? Do you somehow have to "share in the cost" for doctors working for the government at a VA hospital or something?

Do you really deal with "100's of insurance companies"? I have 4 choices of companies in marketplace plans, and that's in a major metro area in FL. (I could only find a list of 12 companies authorized to operate in FL.) Most doctors seem to take 1 or 2 of the 4. The problem is, doctors can't even tell you the amount they will BILL the insurance company (I get if they're not 100% sure of deductibles & such), because some make up essentially random numbers hoping to get lucky on a few high reimbursements or nailing uninsured patients, and in other cases accept 20% or 50% of the randomly-billed amount. That is a common billing practice, it's not the insurance companies or patients making doctors do that.

Even when I pre-pay in cash at a doctor's office, I often end up getting a bill in the mail for double the agreed-upon price. I guess they just hope some percentage of people don't notice and pay twice? That's fraud. Happens to me all the time at doctors. But I've never once billed a client again for something they already paid.

Listen, I'm not trying to blame all of these on you, and I do understand the medical billing system is complex, and that I don't know enough about it to fully fix it either. But I also know even from my limited personal experience that it is difficult or impossible to ever figure out how much a medical visit will cost before it's done, and that is simply not a fair system. It's ripe for abuse, and many doctors take advantage.

Once a practice/clinic is bought up by a hospital, it becomes part of the system.  So yes, while I was talking about the ER, because it's the same system, it no longer acts independently.  For instance, the ER may be a loss leader for the hospital, who then makes it up in other areas.  Or the pediatric cardiology service is a loss leader but great for PR, and they make it up from orthopedics.  So when you get a facility fee going to see your primary doctor, that may be used to offset the uninsured patient they had to admit to the hospital. 
My point about the billing is that it's so complex that very few offices actually do it themselves.  They outsource it to billing companies.  The billing companies to get business advertise about their reimbursement rate.  So a hospital may contract with a billing company that promises "high reimbursement", meaning it's capturing all the potential charges from the physician's documentation.  And most physicians just document the patient encounters as they should.  A thorough physician that documents a lot about multiple medical issues is going to "bill" more than one that doesn't.  

Because healthcare is not a 2 party business, it will not act like other 2 party businesses.  I see lawyers as 2 party businesses.  The agreement to service and price is between you and your client.  Even dental care is 2 party.  Dental insurance really is nothing more than a prepayment plan.  That's why it seems so simple that "if I do this, why can't they".  As for medical care, there's too many competing interests.  The government, the hospitals, the physicians, the insurers, the patients.  It's seriously F'ed up.  

Now assume people agree healthcare is not a right, assume that if you can't pay for your healthcare you won't get any, even if you just got shot in the chest, assume patients pay up front and patients deal with reimbursement afterwards from insurance companies...ok now you have a 2 party business and prices will seem a lot more fair.  But this will never happen.  So I predict it will stay F'ed up.  

 

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My HMO charges these b.s. fees but my insurance covers the fees even though my Sky-high annual deductible has not been met.

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bighitter said:   
svap said:   
  "...the result of an obscure change in Medicare rules that occurred nearly a decade ago.Called “provider-based billing,” it allows hospitals that own physician practices and outpatient clinics that meet certain federal requirements to bill separately for the facility as well as for physician services. Because hospitals that bill Medicare beneficiaries this way must do so for all other patients, facility fees affect patients of all ages. Doctors’ offices owned by physicians and freestanding clinics are not permitted to charge them..."
http://khn.org/news/fees/

I wonder if there have been changes to the rules since khn.org's 2009 article that you linked.  The dermatologist's office that I mentioned in the original post is not in a hospital. The office is in a regular high-rise office building with numerous tenants.  On second thought, perhaps the hospital is allowed to identify a suite of offices in a building as an outpatient clinic.

  There's no requirement that they be in a hospital -- just that they are owned by a hospital and within X miles of the hospital. I complained about one of these charges for an investigatory procedure on a family member, and the hospital billing people said that all their clinics within a certain distance of the hospital could and did bill a facility fee. 

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Chargum85 said:   I love how healthcare is one of the few professions where it's okay to not tell you what the service will cost and then send you an outlandish bill with no justification for each fee.

Any other service industry would end up being destroyed if that were the case.

  
I don't understand why the insurance industry doesn't treat hospitals/clinics like they do some other medical professionals who practice privately, like mental health workers. For example, insurance companies typically reimburse hospitals by percentage. But mental health professionals (who accept insurance) are typically reimbursed by a fixed contractual rate. So the insurance company can tell the hospital I'll reimburse you 35% for X-rays. The hospital cries that's nothing and hikes up the price enough to make a healthy profit from the 35%. All of a sudden, $100 x-rays skyrocket to $1200 x-rays. A mental health professional tells the insurance company they charge a flat fee of $120 for a 60 minute session. The insurance company turns around and says, 'Too bad, you can only collect $49 bucks total for that visit (including the co-pay), nothing more'. The insurance company allows the hospitals/clinics to makes off like a bandit. And people wonder why a lot of mental health professionals refuse to accept insurance. That mental health professional knows they can realistically only see 5 to 8 patients max in a day, but the hospital churns out a hundred or more patients in the same amount of time - charging them hundreds of thousands of dollars. Hospitals are allowed to game the system. 

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Pobre said:   
tante said:   this is an untended consequence of ACA. Part of trying to get every doctor office's on electronic medical records was them entering to agreements (affiliate, CIN, etc) with hospitals, who were already electronic. Or being completely bought out by the hospital. A way of recouping the cost is to now charge facility fees when you visit the doctor. It is part of the price we all pay to drive data back to analytic systems to help eradicate disease as well improve your care across facilities.
  
Facility fees have around longer than the ACA has. When my son (now 22) was a few months old, he need orthopedic visits and treatment. We were charged facility fees when we saw the Dr in the hospital outpatient clinic, but not in his other office.

Are the doctor's charge lower when done in his other office -- than the charge when done in the hospital?  I am thinking that the facility charge is the equivalent of a separate charge for doctor's rent al expense???

Skipping 9 Messages...
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JepJepJep said:   Paragon said:   
I don't mind because my Dr is awesome and he deserves every bit of blood he can get from the insurance turnips.

 

Do you honestly think that it is the insurance company paying doctors and not the people paying premiums?

OP doesn't care that the taxpayers are taking the hit.

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