Was
your bill at the doctor more than you thought it should be?
You may owe a facility fee when you go to a hospital-owned
outpatient clinic. In other words, when you see a doctor at a facility that is
owned by a hospital, rather than owned by the doctor. These facility fees help
the hospital maintain the clinic by offsetting operational costs.
If your doctor’s office charges you a facility fee, it will be in addition to
the cost of your medical care. Your doctor’s office may call it something like
a “room charge.” Facility fees can range a lot in cost; the fee could be $15 or
$150.
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.
Hospital-owned outpatient practices must notify you that you could potentially
be charged for use of the facilities. If they don’t, you should file a grievance
with your plan and a complaint with
Medicare. You may also consider switching to a different
provider in the future to avoid these costs.
