Facility fee at hospital

[hipster dufus]

Wife has outpatient surgery at northside tomorrow.hospital is charging us a facility fee. Anyone deal w this? Is it legal? My insurance, kaiser, only has a 200$ copay for outpatient surgery. In 2020 I had a biopsy done, hit with a 200$ copay at hospital, same in 22 when I had shoulder done. No facility fee then. Little upset bout this.

 

[sinclair1]

Wife has outpatient surgery at northside tomorrow.hospital is charging us a facility fee. Anyone deal w this? Is it legal? My insurance, kaiser, only has a 200$ copay for outpatient surgery. In 2020 I had a biopsy done, hit with a 200$ copay at hospital, same in 22 when I had shoulder done. No facility fee then. Little upset bout this.

We scheduled my wife’s surgery yesterday. They said since she was in good shape, they could do this outpatient and at the surgery center instead of the hospital.
I didnt think anything about it until you posted, he said they own the surgery center, so it’s a little cheaper?

 

[hipster dufus]

My research so far has me dumbfounded. My mistake was paying up front. Hard to negotiate now. Why do they make it so hard to get a number from these medical people?

 

[oldfella1962]

I don't want to sound like I'm complaining - I have great insurance overall - but this kind of surprised me about the general "thought process" of how insurance companies operate:
as some of you may know, my wife is in the midst of a life-threatening medical situation and imagine how surprised I was that I will be charged 180 dollars by Humana for a "facility fee" because my wife did not go through the "proper referral procedure" of her Primary Care Provider submitting a referral to Humana/Tricare before she went into the (on a military base hospital mind you) ER and subsequently the ICU.
Bear in mind that her situation began unexpectedly on a Saturday!
Even during the Monday-Friday work week it takes 72 hours for her Primary Care Provider to even respond to a patient's request for a referral.
Color me crazy, but if paramedics & doctors are saving your life then you probably don't have several days at a minimum to wait for a referral to get approved. It's not about the money - it's about common sense. If I bypass my Primary Care Provider for non-emergency/routine specialist care, then by all means, charge me a facility fee. But for emergency care?

 

[Dr. Strangelove]

I work for the state (GA) and we have what passes for "good" insurance these days.

I'm at a loss how if my insurance provider has negotiated a fee for a service, procedure or office visit I'm liable for anything other than my copay and co-insurance if I have not met my deductible or out of pocket maximum.

I pay approximately 10% of my salary in health insurance premiums, then I have about another 10% to meet the out of pocket maximum.

I'd say nickeled and dimed but I'm $20-$200'd every time I go to a healthcare provider.

I've worked for the state for 3ish years now and my deductible and out of pocket have doubled. I pay more for less coverage very year and I'm sick of it, then all the extra fees piling on just incenses me.

 

[hipster dufus]

I got my facility fee refunded, didn't even ask , they sent me a check. They were only suppise to charge me the normal outpatient fee, 200$, refunded the overage. Where is the transparency?

 

[transfixer]

Insurance is the biggest monetary scam we deal with , its basically legalized theft, and we cannot negotiate prices, insurance is a huge reason our health care costs are so high , when you price a procedure or test and its $1800 with insurance, and you haven't met your deductible yet, but its only $600 if you pay cash ? you realize how much of a scam insurance really is !

 

[bullgator]

Insurance is the biggest monetary scam we deal with , its basically legalized theft, and we cannot negotiate prices, insurance is a huge reason our health care costs are so high , when you price a procedure or test and its $1800 with insurance, and you haven't met your deductible yet, but its only $600 if you pay cash ? you realize how much of a scam insurance really is !

Insurance companies and politicians are in bed with each other. Once we were forced (required) to have health insurance it gave those companies less incentive to be competitive and the green light to manipulate us. Add to that the hospitals and others the opportunity to invent new costs. Now it’s like dealing with car lots.

 

[oldfella1962]

Sort of related to the topic - a big thing here in Augusta (maybe other locations too) is shooting victims driving themselves to the hospital.
I think I know why - ambulance/emergency services are very high if you don't have insurance or have suboptimal insurance. Yes, the ER will treat any & all emergencies that show up no matter what, but getting you from Point A to Point B? Maybe not, because ambulances & medical transport companies are private/contracted companies. Experts weigh in here please.

 

[Batjack]

Sort of related to the topic - a big thing here in Augusta (maybe other locations too) is shooting victims driving themselves to the hospital.
I think I know why - ambulance/emergency services are very high if you don't have insurance or have suboptimal insurance. Yes, the ER will treat any & all emergencies that show up no matter what, but getting you from Point A to Point B? Maybe not, because ambulances & medical transport companies are private/contracted companies. Experts weigh in here please.

Not a "expert" by any means, but the last bambulance ride I took cost 12 grand for 4 miles. Not begrudging the E.M.T.s or Paramedics.. they work hard and earned their way.. but 3 grand a mile is a bit much for someone that passed out due to blood loss. I bet the the 3 folks on there didn't make a grand total for that trip.

 

[Ruger#3]

Sure there’s corruption in the system. However if you want to see rate drop quick recind the law making nonprofits take those that can’t pay. I know of one case where the individual owes the hospital over 3 million. That person is a frequent flyer and will be back within weeks.

 

[oldfella1962]

Not a "expert" by any means, but the last bambulance ride I took cost 12 grand for 4 miles. Not begrudging the E.M.T.s or Paramedics.. they work hard and earned their way.. but 3 grand a mile is a bit much for someone that passed out due to blood loss. I bet the the 3 folks on there didn't make a grand total for that trip.

Small world! I drove myself to the hospital when I was bleeding out about six years ago, but at the time I had no idea of how much blood I had lost until I had to walk from my car to the ER and it was an uphill walk - my legs were shaking like my shoes were made of concrete or something! Now for the funny part - my "deductible/co-payment" for a standard ambulance ride from my house to that hospital would only have been about 50 dollars.

 

[SC Hunter]

Not a "expert" by any means, but the last bambulance ride I took cost 12 grand for 4 miles. Not begrudging the E.M.T.s or Paramedics.. they work hard and earned their way.. but 3 grand a mile is a bit much for someone that passed out due to blood loss. I bet the the 3 folks on there didn't make a grand total for that trip.

I'm a paramedic and assistant director of a county based service. That bill sounds absolutely ridiculous. Where do you live and what ambulance service was that??

 

[Batjack]

I'm a paramedic and assistant director of a county based service. That bill sounds absolutely ridiculous. Where do you live and what ambulance service was that??

Metro. They took me to Paulding which is right at 4 miles.

 

[1eyefishing]

It may have something to do with whether or not the doctor has 'admitting privileges' at the hospital?
If he is not associated closely with that hospital he may just be 'renting' the facilities?

 

[oldfella1962]

I'm a paramedic and assistant director of a county based service. That bill sounds absolutely ridiculous. Where do you live and what ambulance service was that??

Did they give you a blood transfusion along the way? Just curious - I know the last time I got a couple of transfusions in one day it was over 1,000 dollars a "unit" so a dozen units or so really adds up fast - assuming you have to pay "put of pocket" of course.

 

[Stob]

It may have something to do with whether or not the doctor has 'admitting privileges' at the hospital?
If he is not associated closely with that hospital he may just be 'renting' the facilities?

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It is beginning to change, from what I hear, but most doc's at a hospital are contactors for themselves or a group of docs. Businessmen first, doctors second.