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Insurance companies may not cover facility fees

On Behalf of | Apr 1, 2020 | Insurance Law |

Patients want to know what they are paying for before they receive care, but few are actually given that information. This is because more and more people in Washington are having to shell out for much more than just their copays. Facility fees are driving up the cost of seeking medical care, and they are becoming more and more common.

One out-of-state woman learned about facility fees only after she ended up owing nearly $600 for seeing a doctor about back pain. Her $45 copay only made up a fraction of the total bill, with the rest of the bill coming from the $550 facility fee. She was not aware of the facility fee before seeking medical care, especially since she chose her medical insurance because it supposedly made the out-of-pocket expenses very clear.

These facility fees are generally from outpatient facilities, which are regulated the same as hospitals. This means that they are required to separately bill for the provider and the facility fee. Since hospitals are buying physician’s practices more frequently, the problem is likely to get much worse in the future. Insurance companies do not cover much — if any — of these costs, either. This leaves people owing hundreds of dollars for a single trip to the doctor.

Some patients in Washington might struggle to find medical care that is not in an outpatient facility. But what some may not realize is that it is possible to dispute facility fees, even when medical facilities insist that they are required. Being assertive about one’s rights and policy coverage can be helpful when disputing these claims.