I went to the doctor last month and now owe more than I thought I would. I called the office and learned that they charged me a facility fee. What is this? -Roman (Baton Rouge, LA)
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.
I hope this helps!
The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.