How a trip to the doctor can cost 3 times more than you expect
When Jan Trefzer went to a doctor for back pain, she expected to pay $45—her insurance copay for specialist care.
But Lee Health billed her insurance for facility charges both times Trefzer went to the doctor at the Sanctuary, an outpatient center in Fort Myers.
Those facility charges added $550 to Trefzer’s total out-of-pocket cost to see the doctor.
“Both times the doctor didn’t even lay a hand on me,” she said.
Lee Health also billed Trefzer’s sister-in-law Virginia Bogue a facility fee for a cardiology appointment at a physician’s office off of Bass Road. Bogue has special needs and is on a limited income.
The charge made the bill go from $40 to around $120, according to Trefzer.
“We chose her Medicare insurance based on known co-pays, known deductibles, known expenses,” said Trefzer, who is the medical power of attorney for Bogue.
Trefzer disputed the charges and was refunded one of the fees for her bill, but Lee Health would not budge on the charge for Bogue.
“I had to find her a new cardiologist,” said Trefzer.
Lee Health said it tries to keep charges as low as possible and some practices are going to be higher than others.
“We have financial assistance programs available for people who are underinsured or uninsured,” said Mary Briggs, the system director for strategic communications and public relations for Lee Health.
She explained that hospitals are required by law to charge facility charges separate from the charge for a physician and provider.
Outpatient facilities have the same regulations as a hospital and cost more to run, and those charges are billed to the patient.
“We completely understand how frustrating the billing system is in healthcare today and we agree it’s broken. There is work being done to fix it, to make it more transparent and we want to be part of that solution,” said Briggs.
But a healthcare billing advocate with no affiliation to Lee Health said facility fees are hurting patients’ pocketbooks around the country.
“If you are running a clinic in a strip mall that’s 10 miles from the hospital, what are the real, additional costs? Because it’s got the hospital system’s name on there,” said Jon Hess, with Athos Health.
Athos helps consumers navigate and dispute medical bills and insurance problems.
He said as more hospitals purchase physician’s practices, consumers can expect to see facility charges for everything from physical therapy to mental health treatment.
“It’s a pretty big problem and it’s growing,” he said.
Lee Health posts signs that alert patients they are entering an outpatient facility and also provides paperwork at check-in alerting patients about the facility charge.
Hess said these legal requirements do nothing to help explain to consumers what their actual, out-of-pocket cost will be.
He said if you see the sign, it should be a red flag that you are going to get two bills.
“This is going to be twice as expensive if I just went to a doctor that wasn’t part of a hospital,” he said.
Trefzer and Bogue are going to doctors who aren’t at outpatient facilities and said they are now just responsible for their known copays.
Both Briggs and Hess agree if you see an outpatient facility sign, you should ask if there will be a charge and try to find out from your insurance company how much of it will be covered.
But Hess advises consumers to avoid hospital outpatient facilities altogether. If you can’t avoid them, he recommends disputing the charge.
“Formally dispute those, say, ‘I don’t want to pay the facility fee.’ Some places will waive it, some places won’t and you can decide what you want to do moving forward,” he said.
WINK News is taking an in-depth look at health care in our new Cost of Care series. If you have a story you want to be heard, whether it’s a high medical bill, an insurance dispute or a medical procedure gone wrong, send us an email to [email protected].