Facility fees startle patients who think they’re paid up: “Cracking the Code”

Filed Under: Costs, Health plans, Patients

“When Nancy DuBois began experiencing shoulder pain early last year, she worried she might need rotator cuff surgery. She saw a specialist at Tulane Institute of Sports Medicine, near the Tulane football stadium, who diagnosed her instead with a frozen shoulder, a common condition caused by injury or over-use. The visit, including an x-ray and a cortisone shot, lasted about 30 minutes, she said,” writes our partner Jed Lipinski over at NOLA.com I The Times-Picayune in New Orleans. “A month later, DuBois got a bill from Tulane University Medical Group. It said she owed $100 out-of-pocket for the doctor’s visit and the injection, on top of her $50 co-pay, according to the bill. She was okay with that. The next day, she got a second bill from Tulane Medical Center for a hospital visit, drugs and x-ray. This one said she owed an extra $137.

“DuBois was puzzled. She’d gone to a sports medicine clinic, not a hospital. She called Tulane Medical Center to dispute the charge, she said, but a representative told her it was correct. That’s when DuBois learned about ‘facility fees.’

“‘The lady told me, ‘Whenever you see a doctor there, you may incur a facility charge,'” DuBois, a retired office manager and bookkeeper in Metairie, recently recalled. ‘When I contacted Blue Cross, they told me the same thing: “‘If the hospital owns the clinic, they can charge you a facility charge.'”

“‘It didn’t make any sense,’ she added. ‘What are we paying for, their rent?'” Jed Lipinski, “Surprise ‘facility fees’ in many New Orleans area hospital bills often exceed doctor’s fees” NOLA.com I The Times-Picayune.

Here’s the FOX 8 Live story by Lee Zurik “One consumer’s lesson, from shoulder pain to facility fee.” Click on the link or the image at right.

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