Wednesday, November 18, 2009

Facility Surcharge for Doctor Visits

Consumers must always be careful of hidden fees and unexpected charges when purchasing healthcare services. A new version of hidden fees has been gaining attention the past several months: Called "provider-based billing", there is a rule that allows hospitals that own physician practices and outpatient clinics that meet certain federal requirements to bill separately for the facility as well as for physician services as long as the bill all patients for it.

What does this mean? If you go to your doctor for an office visit, you expect to pay for the office visit. If you happen to go to a doctor that is owned by a hospital, then you may also be charged a "facility charge". According to Kaiser Health News facility charges can range from $25 to hundreds of dollars. Unaware consumers can be in for quite a surprise.

One of the troubling issues that results is the fact that this hidden billing has its largest impact on uninsured and self-paying patients. While the Medicare program allows hospital owned physicians to charge the facility fee, Medicare typically dictates a below market fee schedule for the physician services. Private insurers can also negotiate set rates that eliminate the facility fees. Self-pay patients are left paying the full amount of the physician bill plus the facility fees.

Given the recent increase in physicians joining hospitals as owned practices, the issue of facility fees is likely to grow.

For other reports on this see:
Cleveland Plain Dealer
USA Today

Sunday, November 8, 2009

$100M Healthcare Pricing Database

We have been following the NY attorney general's cases against Ingenix and large health insurance companies. The attorney general recently announces where the $100M in fines will go and what they intend to do with the healthcare data.

They will create a new Non Profit entity called FAIR Health that will be centered at Syracuse University. Other NY universities will share in the money and collaborate on the project.

FAIR Health will ultimately offer pricing information to consumers on a new website they intend to create. It should help consumers understand typical Insurance company reimbursement for out-of-network care. They hope to have the website up within one year.

You can view the attorney general announcing FAIR Health here.