Facility Fees Leave Patients with Large Surprise Medical Bills

Ellen, a Long Islander, received an unexpected and unwelcomed bill from a hospital system when she went to her doctor’s office for a biopsy.  She was not anticipating a “net facility charge” of $2,142 which she was not informed of.   She protests that she was not provided with any notice that she would be charged extra for a facility charge when she was visiting a doctor.  She also received a bill for net charges of $618.07 from the Doctor.  “Had I known that was the billing practice, I would not have visited this doctor,” she says.

She adds, “There was nothing from the doctor or her staff, or from the circumstances of the procedure, that would have indicated to me that I was being treated at a hospital.  Both the examination and the procedure took place in a typical examining room at the doctor’s office. I was not even placed on a special chair for the procedure— I was wearing my street clothes.”  The facility fee is not a charge for an actual health service.  As of now, it is a legal way for the hospital that bought your doctor’s office or clinic to add the hospital’s overhead cost to your doctor’s bill.  Health Insurance often will not pay these facility fees, leaving the patient stuck with the bill, uninsured patients are always stuck with these facility fee bills. 

A new bill, the (A3470B/S2521B), would regulate these health care facility fees and provide some semblance of protection by not allowing a provider to seek payment of these fees if not covered by insurance, unless they had notified and explained the fee and amount at least seven days in advance of the procedure.  If approved by the New York State Legislature and signed into law by the Governor, the would ensure that patients will no longer be held responsible for this kind of surprise bill and what happened to Ellen will no longer happen to any other New Yorker. The bill would also prevent facility fees for preventive care – New York will be the first state to do so if it passes!

Each year, the Department of Financial Services reviews applications from insurers in the individual, small group, and Medicare Advantage markets and decides whether rates should go up, down, or stay the same. This year, insurers are asking for an average increase of 11.7% in the individual market, which is too much for consumers to manage especially in the midst of the economic and health-related repercussions of the COVID-19 pandemic. Submit your comments here by July 5.

HCFANY found plenty of reasons in the individual market filings to reduce or even reverse those increase requests. Find your carrier in the list below to see what we had to say!

New York City health care leaders called for more city and state efforts to address health care affordability during a panel discussion this morning at the Community Service Society of New York. Speakers including Dr Mitch Katz, NYC Health + Hospitals President and CEO; Rodrigo Sanchez-Camus, Director of Legal Services at NMIC; Mark Levine, Chair of the NYC Council’s Health Committee; and Elisabeth Benjamin, Vice President of Health Initiatives at the Community Service Society of New York. David Sandman, President of the New York State Health Foundation, moderated. (You can view a recording of the event here).

Panelists discussed solutions including a single-payer system, a city-funded consumer assistance program, and an overhaul of medical billing practices that leave patients paying more than they owe out of confusion and fear. The event also served as a launch party for a new grassroots effort called We the Patients (read more here) that gives New Yorkers as opportunity to advocate against unfair health care practices.

The panel was inspired by a survey (available here) which found that 50 percent of people in New York City had taken steps like cutting a pill, not filling a prescription, or skipping a treatment because they could not afford it. Most of the people surveyed had insurance.

Those results show that New Yorkers need help using their health insurance and fighting unfair medical bills. New York pioneered a model for providing that help called the Managed Care Consumer Assistance Program (MCCAP). MCCAP provided technical assistance to people enrolled in Managed Care Plans, including direct advocacy with insurance plans and legal assistance for things like inappropriate claims denials. Today all New Yorkers have access to that assistance through the Community Health Advocates and Navigator programs. Panelists suggested that the City provide its own funding to boost those services because of the disproportionate impact the affordability crisis has on city residents.  

The panel also discussed the role of hospitals and unfair billing practices in New York’s health care affordability crisis. One of the examples included an almost $300 facility fee charged to a person for what should have been a free preventive mammogram because it was provided in a hospital-affiliated practice. Some of the solutions discussed include eliminating the use of facility fees, requiring consolidated and standardized bills, and requiring that all hospitals use standard financial liability waivers so that patients are protected from signing away their rights before receiving medical care. We the Patient’s first petition focuses on seven common billing practices that result in patients owing more than they should (you can sign the petition here).

A new survey found that most New Yorkers still struggle to afford healthcare and are worried about affording care in the future. This probably isn’t news to many of us – but the findings make the state budget’s lack of action on health care even more glaring.

New York has traditionally been a healthcare leader, and we have one of the lowest uninsured rates in the country. But insurance isn’t enough. Many of the survey questions were asked of insured New Yorkers. They are having trouble managing the costs of their premiums, co-pays and deductibles.

The survey shows the toll this takes – almost half of New Yorkers (45 percent) have avoided care or taken drastic actions like cutting pills in half or not filling prescriptions. Over a third of New Yorkers (35 percent) reported serious financial repercussions including using up all or most of their savings, being put in collections, or being unable to pay for food, heat, or housing on top of medical bills.

New Yorkers from upstate and downstate and from both political parties want government action on healthcare costs.

New Yorkers blame health plans, the pharmaceutical industry, and providers like hospitals almost equally. They are ready for the government to step up and do something. But the only proposal in the governor’s budget that could address costs is one that would license pharmacy benefit managers. That’s a great start in reining in prescription drug costs, but it’s a step many other states have already taken. The state could do a lot more to help New Yorkers manage this problem, including a state premium assistance program, a drug utilization board that could set prescription drug rates, or creating a public option for the lowest-income people in the individual market (see our budget testimony here for more information).