How much does a blood pressure check with a physician’s assistant cost, $25 or $464?

Filed Under: Costs, Health plans, Patients

A blood pressure check and medication adjustment with a physician’s assistant costs $464? How can that be?

The share was from New Orleans, and the provider is University Medical Center, a part of LCMC Health, the big New Orleans chain.

“University Medical Center charged a $308 ‘facility fee’ and after insurance discounts I’m out of pocket $244 towards my deductible and a $25 copay,” the community member told us.

She paid a $25 copay, as is usual at this clinic, and was billed for an additional $244.84. The insurer paid $31.91.

I asked few questions:

1. You saw a physician’s assistant for blood pressure check and med adjustments? Can you tell us about the circumstances?
2. Do you have an explanation of benefits or bill you could share with us? Please feel free to black out any identifying details.
3. Was the $308 facility fee in addition to the doctor’s charge?

She replied:

Hi,
I had read the Lee Zurik/NOLA.com report and remember hearing about the facility fees, I went back to it after this one was assessed and found my way to your site.

1. Yes. I’ve been seeing both my doctor and the PA for several years now. Initially the doctor was based at a Mid City LSU family medicine facility, and she moved over to University Medical Center more than a year ago. I’ve seen her and the PA numerous times at UMC, and have never been assessed a facility fee before my 5/29 visit. At an April visit with the doctor I requested a change in my blood pressure medication because of side effects that were problematic. This was easily changed, but my doctor requested I return in a month and check in with her PA to see how effective the new medication was. I visited the PA on 5/29, my blood pressure was checked both on their equipment and the monitor I use at home. Based on the readings I’ve collected at home my meds were adjusted. I was there for maybe 15 minutes.

2. I’ve attached my EOB from the insurance company as well as the bill from my UMC “mylcmc” account. I also received and paid a separate bill from the provider, but I’m afraid I no longer have a copy handy.

3. Yes. The 308 “facility fee” was in addition to the doctor’s charge. Neither the bill from UMC or info provided by my insurance company indicates that it is a “facility fee” – I only got that information after a call with a very unpleasant person in the billing department at UMC.

I asked again:

1. So this charge was for the PA visit alone on 5-29. And that was the total charge for that visit — no PA fee? Or doctor fee? Just the facility fee?

2. Put another way: The separate bill from the provider that you mention — was that for this same visit, or the April visit?

What I’m getting at: If you had a $308 facility fee PLUS a doctor’s fee for this visit — when you saw a PA and got a blood pressure check — that is unbelievable.

She replied:

I agree, unbelievable! Both of the charges for the 5/29 visit should be itemized on the EOB. $308 was billed to my insurance, simply listed as “OUTPATIENT SERVICES” that’s the “facility fee,” the eob indicates plan discounts of $63.16, and an out of pocket of $244.84. The charge submitted to my insurance by my provider for the office visit was $156. My insurance plan paid $31.91, plan discount was $99.09, and my out of pocket was my $25 copay. The total amount charged to my insurance by both my provider and UMC was: $464.

From what the UMC person told me the “facility fee” had to do with UMC’s recent purchase of the LSU Family Medicine clinic. The customer service person was the first to articulate to me that it was a “facility fee,” but could not explain why I had never been charged this fee for any previous visit to my GP at the UMC location.

I’ve never been asked to pay anything other than my $25 copay before the 5/29 visit.