Doctors are now charging facility fees!
 

I just saw this article on facility fees. I had never heard of them but it seems like a new scam.

Has anyone been charged facility fees??

Did your doctor'''s office charge you a '''facility fee'''? Here'''s what to know.

One of the nightly national news stations had something on the other night. I flip around so not sure which one.

What is a facility fee and why is it important to you? | UCHealth What is a facility fee and why is it important to you? | UCHealth


Not fake news .

So these stories are false? These people were not charged facility fees?

After Cleveland Clinic expanded to Florida, patients say surprise fees followed

Just a moment...

Bummer, but shouldn’t be an issue for those with a good Medicare Supplemental Plan.

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.

There are medical fees: doctor nurse drug charges.
There are facility fees: rent, maintenance, EMR costs.

The facility fees are the overhead costs associated with the building and the systems involved in operating in the medical world. Its separate because of how contracts are written, especially after the installation of EMR systems, and their ongoing costs and requirements for CMS reporting.

Not a scam, just separating charges. . with all other commercial companies, the labor rate usually includes the burdened overhead rate. for hospital billing, its now broken out as the doctor and the facility fees are different vendors.

I charge a patient fee.

According to the article, the fee is being charged by doctors that have been bought out by hospitals. It doesn’t appear that the doctor’s costs have gone up.

Facility fees are commonly seen in hospital-owned outpatient clinics and are increasingly appearing in other outpatient settings when hospitals acquire physician practices.

Didn’t the doctor have rent and maintenance before they started charging facility fees?

This is like a hotel charging $300 a night for the room and then adding on a mandatory resort fee.

The doctor’s fee should be the total cost of providing services plus an added fee for profit.

If you start breaking everything down, the fees are endless.

If a doctor really wants to make money, the doctor could also add a fee for utilities, office cleaning, an office staff fee, a Christmas party fee, etc., etc.

its a billing distinction, of pure doctor / medical and then rent, overhead, etc.
yes, it used to be all in one. . and i will check to see when and who, i suspect CMS, started demanding the two be split out, so that all medical services are identified separately from rent/ operational overhead. medical then should be billed per procedure to medicare. . facilities are dependent upon the local situation. .

the biggest problem is that there are two bills instead of one now.

When they split the cost two ways - doctor/medical and rent/overhead - did the doctor/medical fee go down?

Of course not.

For years if a physician had a on-site procedure room, facility fee was listed separately for use of the room.

What is a procedure room? I have been to a dermatologist and they usually perform a “procedure” on me. Does that qualify?

via Google:

Key Hospital Bankruptcies and Related Events in 2025:
Prospect Medical Holdings: Filed for Chapter 11 bankruptcy in January, citing financial difficulties and seeking to restructure its operations and potentially sell some of its hospitals.
Steward Health Care: Filed for Chapter 11 bankruptcy in early 2025, leading to the closure of some facilities and a focus on restructuring.
The Bellevue Hospital (Ohio): Filed for Chapter 11 bankruptcy and is planning to be acquired by Firelands Health.
East Ohio Regional Hospital: Closed down on March 27 due to ongoing financial issues.
Landmark Holdings of Florida: Filed for Chapter 11 bankruptcy in March, citing financial problems.
Houston Healthcare: Finalized a definitive agreement to join Emory Healthcare.
Jackson Hospital (Montgomery, Alabama): Filed for Chapter 11 bankruptcy.
3 others were acquired before bankruptcy

Factors Contributing to Bankruptcies:
Rising Operational Costs: Hospitals face increased expenses related to labor, supplies, and energy.
Funding Constraints: Difficulty accessing capital and navigating complex regulations.
Medicare Advantage Reimbursement Rates: While Medicare Advantage rates are set to increase in 2026, providers continue to face pressure on reimbursement.
Labor Shortages: Workforce shortages contribute to increased costs and operational challenges.
Private Equity Ownership: Concerns about the impact of private equity ownership on hospital finances and patient care.

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We are only 1/2 way through the year. .
If you think your healthcare isn't going to bill you for every last dime they can. .
so if you want healthcare to exist near you, pay the damn facility fee. . .

And yes, the area hospital in the town where my mom lived, and I grew up, now has no regional hospital. . emergency room is now 45 minutes away, there are several schools systems there, high potential sports injuries,

check out the Healthcare sector valuation in the stock market, lowest of all the sectors, with the weakest earnings growth. .
the US system was the best in the world, and it was the most expensive. . then all of a sudden, with such great health care, people started living alot longer, and the medicare system started costing alot of money in the govt budget. . . and then power hungry people started cutting taxes to get elected. .

shades of 476 AD

I was in the health insurance business for 30 years. These fees became more prominent when healthcare systems started buying up doctor's individual practices since the costs of doing business increased. Malpractice insurance, rent, personnel, equipment and supplies, etc. and other expenses was making it almost impossible for doctors to be in private practice. As the clinical systems took over, they discovered they could recover their investments by charging facility fees, itemizing charges for supplies and pharmaceuticals.

Think about it. You used to go see your doctor in a small offfice with one or two nurses, an office manager and an assistant. Now you see them in a mega building with all the related equipment and supplies. Somebody pays for that. Medicine has become so complicated as technology has evolved.

Does Medicare Advantage have a different reimbursement rate than Medicare??

On the tax issue, we cut tax rates. The issue is tax revenue - not tax rates.

We are bringing in $1.6 trillion more this fiscal year than in 2019. Revenue increased by 45.7% in those six years.

However, we are spending $2.6 trillion more in 2025 than in 2019. Spending went up 59.1% in those six years.

Is it a spending issue or a revenue issue?

- FY 2019:
- Revenue: ~$3.5 trillion (16.3% of GDP)
- Expenses: ~$4.4 trillion (20.9% of GDP)
- Deficit: ~$984 billion (4.6% of GDP)

- FY 2025 (Projected):
- Revenue: ~$5.1 trillion (17.9% of GDP)
- Expenses: ~$7.0 trillion (23.3% of GDP)
- Deficit: ~$1.9 trillion (6.2% of GDP)

“Annual income twenty pounds, annual expenditure nineteen [pounds] nineteen [shillings] and six [pence], result happiness. Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.” ~ David Copperfield

its both and all:

* tax revenue is brought in by tax rates, ceribus paribus. . . (judgmental comment withheld)
* spending issue is due to a fixed govt program and having the volume explode due to demographics of increasing longevity with a boomer based population growth.

JUST SAY NO

If we all ban together and take our business else ware, this latest means to take our money will go away.

All things being equal?

But they are not. The economy is dynamic and when you increase or decrease taxes, it impacts growth and investment and many other factors.

If cutting tax rates increases revenue, would you be for it?
And if raising rates decreased revenue would you be for that?

If all things were equal you could increase the tax rate to 90 or even 100% and really rake in the money.

However, most economists say that a 25% tax rate would bring in more money than a 100% tax rate.

Are you on Medicare? Do you have a decent supplemental policy? If so, you probably don’t need to worry about this. I have Medicare and a Blue Cross/Blue Shield supplemental policy. Between them, THEY decide what gets paid, no matter what is billed, and in most cases the doctors and hospitals are NOT allowed to pass on to me whatever they don’t pay. For example, I had a serious surgery in January and was in the hospital overnight. The total bill came to $131,000. Of that, my insurances paid about $15,000 total, and I had to pay $259. If I get an MRI, I pay nothing and my insurance pays about $150 of a $5,000 bill and cancels the rest. I doubt that any extra facilities fees are paid.

Very good point! I realize expenses increase but do believe they could manage the revenue better. My husband worked for our hometown hospital for 15yrs and 5 of those years did NOT receive a raise. Luckily the hospital merged with a larger hospital which seemed to help a lot!

and you should never not wonder about hospital bankruptcies. . due to the boomer generation just happening to live alot longer due to the effects of modern medicine. .

Medical care gets expensive when you add 20 million people to the system that never paid into it

Consider it a tip.

closer to 50 million

No, the biggest problem is not that there are two bills. The biggest problem is the surprise billing of a charge not mentioned ahead of time. Attached is a screenshot of the recent news segment I saw. The man went in for a routine shot of some kind in his doctor's office. He had this exact same visit in the past. Suddenly there is a facility fee of over $14,000 plus several other unexplained fees for a total of over $17,000 for a routine doctor's office visit. That's just f***ing ridiculous. The man's out-of-pocket cost on this visit was over $700. He later found an independent doctor (not affiliated with a hospital group) where the same service resulted in a $35 co-pay.

This fee / practice should be criminal without clear notice well before the office visit. If I get a notice like that, I drop that doctor like a hot potato. I'll bet an independent doctor somewhere would love my business.

The Epi-Pen story is a classic example that still persists. And there are generics of this product. The actual 0.3mg of epinephrine in each pen costs about 35 cents. But, a pair of these pens loaded with the generic form of this cheap chemical is still priced anywhere from $500 - $800. WTF!! The actual pen is a cheap disposable device that costs about $3.00 to manufacture. Research and development is BS. This device is less complicated than the mechanics of just the print head of an $80 inkjet printer.

Medical costs are high because there is very little market knowledge. People need to be able to see a price list and get a quote BEFORE scheduling service or choosing a pharmacy. Obviously, this is not the case for an emergency situation. But, the vast majority of medical purchases for service and pharmaceuticals are routine. I should be able to visit multiple websites to see both patient reviews of doctors' services as well as the cost of various services by same. Ditto with pharmacies and costs for drugs - a complete price list made public. And perhaps some kind of mechanism where the consumer is rewarded for making better economic choices with that information. For example, make the co-pay (there should always be a co-pay, never a no-cost transaction) a percentage of the price giving the consumer (insured or not) the proper incentive to make good choices. Competition works but not when prices are hidden and surprise billing exists.

With a Medicare Supplement plan you will not see this extra charge. On the other hand, with an Advantage plan you very well could get stuck with it.

Your suggestions are excellent. Hopefully the medical professionals on TOTV will discuss it.

And $14,000 for a facility fee!!!!

No wonder states are trying to regulate them!


States move to put limits on health care "facility fees"

All facility fees must be in the Summary of Benefits.

We've been told since forever that combining small medical practices into conglomerates would LOWER costs since equipment is duplicated across many small offices as well as redundant staff. I see this as nothing more than a scam by the health care providers to get more than reimbursements from Medicare. My first thought is "Obamacare"....what was buried in that bill that possibly caused this? Remember Obamacare wasn't forever so I have a feeling some timebombs were planted to keep costs low for a while but sooner or later someone (in this case the consumer) has to pay the piper. Paying facilities fees is just their way of bleeding Medicare recipients directly since secondary insurance providers won't pay the fees either. Just direct out-of-pocket from the victim/patient.

I just found this online.

UHC The Villages Medicare Advantage FL-004P.

Enrollment stands at roughly 18,891 members.

UHC The Villages Medicare Advantage FL-0004.

As of May 31, 2025, plan enrollments topped 23,865 members.

I can't find enrollment for the other plans.

One step closer to National Health Insurance