Insurers have long paid facility fees for care that occurs in a hospital to help cover overhead costs. Eliminating these fees for hospital-owned off-campus practices can be hard, because hospitals do the billing and often do not indicate where the patient was treated. Insurers — and consumers — also are charged facility fees for care at outpatient surgery and urgent care centers that are in hospital-owned networks. Partners HealthCare and Steward Health Care, two large hospital networks, said they charge facility fees at some doctors’ offices.
Dolores Mitchell, head of the Massachusetts Group Insurance Commission, which insures 375,000 state employees and retirees, said she is working with health plans to eliminate these fees. Meanwhile, the commission advised members in a newsletter to question doctors about whether a visit will generate a facility fee; if yes, let the doctor “know you are not happy about’’ it, it said.
Consumers should at least know ahead of time if they are going to have to pay a facility fee, said Eric Linzer, spokesman for the Massachusetts Association of Health Plans. Eventually providers and insurers will have to make detailed price information, including facility fees, available to consumers under the state’s new cost-control law.
Cigna spokesman Mark Slitt said he could not discuss Reed’s case because of patient privacy laws. But the insurer is talking to providers about limiting facility fees in contracts, he said. Meanwhile, members can log on to the company’s website to compare costs for certain procedures at different sites, including whether they will be charged a facility fee.
Reed, who has been trying to untangle his dermatology bill for nearly a year, said he did not research the procedure on Cigna’s website, because he did not know he was going to have it until he was in the exam room. When he looked it up after the fact, there was no cost information on the Wall Street location. And even the prices listed for the main Lahey campus were difficult to understand and seemed far below the amount of his bill, he said.
Since his family has a history of skin cancer, his primary care doctor had recommended he see a specialist. The Wall Street practice is near his office, so he made an appointment with Dr. Ava Khosraviani, who is no longer employed by Lahey and could not be reached for comment.
The first bill Reed got was the $354 for her services, of which his share was $210.59. The second bill was for the operating room and facility charges. When Reed complained to Cigna about the bill, saying he never had an operation, he received another bill that called the $1,525 charge just a facility fee.
However, the amount he owed grew, because Cigna’s negotiated discount had shrunk with the change. Now he has complained to his employer, which is appealing the bill to Cigna and Lahey.
“If I had known it would have cost $1,500 to have my face squirted, I would have walked out,’’ Reed said. “This is a doing-business-with-Lahey charge. They’re saying we get a premium because we’re Lahey Clinic. It doesn’t have to do with the cost of the facility.’’