"Facilities" Fees?!?...(Sorry, a bit of a rant)

A couple a days ago, we received a request from our supplemental insurance for information regarding an outpatient visit on 7/13 for Crawford Long Hospital (Emory). We did have an appointment at Winship Cancer (Emory Clinic) on that date, but we didn't enter the hospital across the street. I checked, and sure enough, it had been billed with BCBS first and applied to our deductible. I called Crawford Long's billing department to find out what it might be. I was told it was for "use of the facilities", since they owned the building where Winship is housed. The hospital rep told me that we were charged the same thing on 2 prior occasions (but for some reason had not yet billed us, or the supplemental insurance). Bearing in mind that our doctor's visit was in excess of $480.00, and the bloodwork was $790.00, I was a little stunned that they charged and ADDITIONAL $428.00 for use of the facilities.

Has anyone else noticed these fees? My daughter (who works for a health insurance company), said they have been around for a little while and are becoming more and more common.

Doing the math....our doc tells us he see around 40 patients on clinic days (2 per week). That comes up to $17,120 per day per doctor (more or less). Figuring 100 clinic day per year - $1,712,000 per year/per doc. The clinic where we go has at least 6 docs, so $10,272,000.00 per year. There are several clinics in just the building where we go. So, not for any medical services, just for being seen indoors, we are now being charged this additional amount. Am I the only person who finds this outrageous?

Donna

JNF,

We are blessed to have both a really good primary policy and a "gap" supplemental policy, but that's rare these days. It's sad that price gouging is a thing in medicine. We love the docs we see at Emory. It's very disappointing that we have no choice but to go along, if we want to continue to see our docs.

Donna

RandyJoe,

This highlights another twist in the maize of medical delivery these days. In March I was amazed that my first lupron injection was list priced at about $10k when given at the radiation oncologist office -- across the street from the related hospital. Luckily, "only" about $300 out of pocket. I came to find out the office and radiation equipment are considered part of the hospital. This also explained the high office visit fees. My second lupron shot I asked to have done at the local related satellite oncology office. I chose it mostly to save the three hours of round trip driving to the RO office. As I also guessed, the injection list price was lower, about $8k and the out of pocket was around $120. I was happy to save time and money, but disappointed that this is information was provided by the School of Hard Knocks, not by intuition and certainly not provided by the institution.

In the future, possibly bloodwork and injections can be handled by a satellite office or lab of the main facility.

Best of luck,
Jim

Angry is not the word. It is time to shut down the medical criminals. Medical consumers including you and me and the government are being victimized daily by the medical corporations, pharmaceutical companies and insurance giants.

It is time for universal medical coverage run by the federal government.

JNF's explanation is correct. I encountered this practice about six years ago. I went for an initial visit with an oncologist when my HT failed and his office was in the hospital. The charge for a 30 minute visit was $428. I was uninsured at the time and paid on the way out. I thought that was a bit much for the visit and I got nothing of use from the doctor. He mostly just stared at me. (Later I thought he intentionally made it a poor experience to discourage me from coming as I was uninsured.) about a week later I got a bill in the mail for "hospital services" for another $110. When I questioned it I was told this was for support of the doctor...office staff, excluding nurses, equipment and building.

On the subject of non profit this hospital showed a "surplus" of $750 million dollars on operations. They also showed a write of for indigent care of something like $100 million give or take. The city I lived in had a population of 155,000. There were two hospitals in the city. If you do the math the surplus and write off come to approximately$5400 dollars a year for each inhabitant. By the way I had my fiducials done at this hospital and paid full cost of $6000 upfront. Would not discuss any discount even for cash payment.

Having insurance avoids a lot of the ugliness of dealing with the medical business. I believe it is a business model in sore need of revision. I have other stories about dealing with cancer with no insurance but I won't bore you all with it today.

Don

To lifeguyd, I don't see why single payor would fix facilities fees as they are charged to Medicare now. They are also part of the VA system but probably not as transparent. In Canada the payor is the government, but the providers are private, so they too would have some variation of facilities fees. The two are unrelated as far as I can see.

The facilities fees are going to be part of any system that needs such facilities and the question becomes how they are charged. Are they charged to only those that actually use them, or can some portion be charged to anyone that uses the general services, but not a specific facility? In our current system, they are spread over the entire user population rather than the specific user. Think what the cost would be to the individual if it were specific.

Without being political, I do agree with John and am not ready to declare that we go to single payor. I have lived and worked in such countries and the public health option is not anything I would have chosen, nor was it greatly appreciated by the local citizenry. Whenever they could use the private systems they would if they could afford to do so, Many countries that have used it are reintroducing commercial insurance back into the mix and most countries like France, Hong Kong, Singapore that have well reputed health care delivery are not single payor, but are hybrids.

Of course the growing movement over the last 15 years has been medical tourism. Look at the large hospital in Bangkok, Thailand. It is named Bumrangrad International and is huge. More than half of their patients come from outside Thailand primarily from nations that ration care and from uninsured Americans. They even show costs of procedures so you can compare with your locale. Their administrator is a good friend and has run joint venture private hospitals all around the world.

So be careful what you ask for as you might just get it!!

Remember the bill is not what matters, it is the actual reimbursement from insurance and Medicare. Bills are always outrageous and can not be used to determine what the procedure cost or what was actually paid. The real information is on the Explanation of Benefits (EOB) that you receive.

The difference between what is billed and reimbursed is usually very significant. For an example, most every six weeks I get an injection of Lucentis in my right eye. The visit, testing, consultation, and injection take about 3 hours and is usually billed at about $9,500. My insurance reimburses the clinic and doctor about $1,700. I don't know what the micro-drop of Lucentis costs wholesale, but it is expensive.

As far as the facilities fees go, there is no question that these are very expensive facilities, machines, technology, and people. We know there is great expense, we just hope we are not being over-charged on an artificial basis.

I believe that many hospitals report on their operating financials so the costs of running them should not be a secret. Look for their annual report, operating statement, etc. Any doctor, hospital or other provider that accepts Medicare has to make a significant amount of public financial disclosure. There is a website where you can see exactly what Medicare has paid a doctor and they always publish a list of the docs that have significant reimbursements.

The EOB says the insurance company paid $346 of the original $428. JNF, you are correct that the insurance company "knocks down" the bill amount significantly. It would just make so much more real-world sense if the services were bill at the same reasonable rate to everyone. There is no possible way to gauge what any given service is likely to cost. And then, they make is worse by "surprise" fees.

Again, we love the docs we see. So, the only way to continue to see our docs is to suck it up. We don't actually have to pay out of pocket for these costs. We're the lucky ones. I just worry that the healthcare system is going to collapse under it's own weight if it doesn't reign in a little of the money grab. This cant' be sustainable.

Donna.

I don't have a link, but you can do some Googling regarding Medicare payments to doctors and should find the information. Most all US government expenditures can be found online.

Regarding charges for services, most all providers will tell you what the costs will be if you ask and remain diligent. I really don't think these are hidden or secretive as TallAllen has explained in his own situation. The psychology we follow when we are the insurance premium payor but not the payor of the service is that all we care about is the co-pay or deductible. Several times on this forum I will see people say it only cost me $3,000 on a $100,000 procedure like they got a deal. They are paying the cost by paying the premium and the deductible and copay.

If we were all more diligent at controlling expenses and procedures regardless of who actually pays the eventual cost, the cost of care would go down. However that really won't happen as we are just too removed from the actual process because of the third party payors.

For example, when we are dx with PCa and the doc says let's do a bone scan. What do we do? We say OK. Do we ask why? How much will it cost? Based on my biopsy and PSA what are the chances I have bone mets? And if we do ask does the doc say well we need a baseline. I went with it as I am sure most of you did as well. How much did all this cost just in our community? How many of us really learned anything that made a difference? Was it really worth it? If we didn't have the scan and learned nothing anyway, what difference would it have made? See the point?

Dreamerboy,

What exactly do you pay for healthcare services in your tax rate. Nothing is free. Good that you had no delay for your surgery. We often hear that elective treatments take many months versus weeks for treatment, hence the fact that so many Canadians come to the US or SE Asia for treatments.

I don't understand your comment about paying for biopsies. We don't in the US if we have Medicare and/or commercial insurance (except for deductibles). Am I to assume you pay for the biopsy in Canada? That would surprise me as I thought everything was free at the point of service. Do you have deductibles and copays for services and prescriptions?

It is good to find out from the patient exactly how the system works in the various countries.

Each provider has to negotiate reimbursement schedules with multitudes of payors. Insurance companies, Medicare, labor unions, employee associations, individual employers that are self insured (essentially all US companies with more than 500 employees), etc. So a large metropolitan hospital may have to negotiate hundreds of reimbursement agreements. Thus they set a billing amount well in excess of any agreement they expect to meet. They know they will never actually collect the "rack rate".

Another example would be MSRP for automobiles. Has anyone in history ever paid it? If the true cost is 15-20% less, then why isn't the car priced accordingly? Same with hotel rooms. Next time check the sticker on the inside of the door of the hotel that shows the "rack rate". No one ever pays it.

Regarding tax rate differences between the US and Canada - this is a fairly complicated comparison because there a taxes at so many levels - Federal, State/Provincial, property tax, investment tax, sales taxes and then the long list of which items are deductible (eg. Canada only has mortgage deductions for income property and not principal residence). I've been searching around and depending which source you use, you get different comparisons. Some even say the middle class pays far less tax here in Canada but I suspect we generally pay a little more. I think this link offers the best comparison analysis:

money.stackexchange.com/questions/5009/comparison-between-us-and-canadas-taxes-and-possibility-of-savings

My plea for "universal medical coverage" is about trying to bring sanity to an out of control system. There are many arguments to be made, but most of us agree that our medical cost and delivery is completely broken.

I would like to see a medical system that does not allow profit to be made on the backs of sick and suffering people. I accept that it will never happen. However, me must work to develop a system that is more about helping people rather than padding the bottom line.

The insurance industry is quickly becoming the major thief, followed by the huge medical corporations and pharmaceutical giants

When I talk of government programs, I hope for Teddy Roosevelt big stick government intervention in corporate size and cost control, rather than government run medical programs.