It pays not to be Too sick-

Not directly related to PTS, but relevant just the same-

Recently a friend told me the experience with Facility fees that seem to be what more and more doctor/hospital relationships are going towards. For example, in the past you may have had a doctor who had an office in a building owned and run by a hospital.  You saw the doctor, and he/she billed an amount to cover the treatment plus whatever other overhead was involved with the visit. And then it was up to the doctor to pay rent so to speak- and cover what that overhead provided by the hospital may be. 

Now, it seems, doctors are being squeezed- probably mainly by Medicare, to provide good patient care, and be reimbursed for less than enough to pay their time, and the fees to the landlord (hospital).  For Medicare patients the fix is already in place. They separate physician charges and facility charges.  For private pay, or private insurance, things have not been set up that way, until now.   Doctors who cannot get reimbursed sufficiently to pay the land lords are entering into agreements where the hospital will take over the billing for facilities charges that have not been separated out previously for private insurance and private pay.  

Recently a friend went to a specialist who had offices in a building run by a local hospital.  They had gone to this doctor before and expected to be billed only for a regular doctor visit. No one at the office said anything different would happen. What did happen was they got billed for the doctor visit, and also for a facility fee by the hospital.  Long story short, the facility fee was twice what the doctor had charged.  For example, the doctor charged around $120 for a certain level of office visit. The hospital billers took that level of visit and plugged it into their model. Out popped a charge for $220.00.  This was for a 15-20 minute visit where the most that was used was a stethoscope, thermometer and scale for the weigh in.  

After a lengthy argument that went up three levels of supervisors, the hospital agreed that the charge was excessive for what they did, and no doubt their protocols need revamping.  They also agreed to reverse the charge totally since they had not chosen to inform patients that this change was happening, and they should have. 

Be careful of unexpected charges, or charges that seem excessive.  I wonder how many patients in this new hospital run group will just go ahead and pay instead of questioning that $200 plus facility charge?  Don’t be one of them!