[jimdecastro]

Originally Posted by Rainger99

Under Original Medicare, facility fees are a covered service, and you are responsible for 20% of the cost of the fee. Medicare Advantage Plans must also cover facility fees, but there is no requirement as to how much of the fees the plan must cover. Because of this, your copays could be high. If your Medicare Advantage Plan denies coverage for the facility fee, you should appeal on the basis that Medicare Advantage Plans must cover the same services covered by Original Medicare.

If you have Advantage, it is probably a good idea to contact the doctor and the insurance company in advance to find out if there is a facility fee and, if so, how much is paid by the insurance company.

All facility fees must be in the Summary of Benefits.