Hospitals Adding New Fees at Associated Outpatient Clinics as States Act to Limit This Practice 

By Consumers for Quality Care, on April 26, 2023

Hospitals Adding New Fees at Associated Outpatient Clinics as States Act to Limit This Practice 

Despite the No Surprises Act being in effect for over two years, hospitals have been adding new fees for services and treatments provided at clinics owned by them. But now, several U.S. states are taking on hospitals that charge exorbitant facility fees that both surprise and confuse consumers.

According to Axios, hospitals are adding “facility fees” for procedures such as blood tests and X-rays performed outside of hospital settings like emergency departments. In some cases, these fees are being applied for telehealth appointments or doctor’s visits at clinics that aren’t located in an actual hospital. 

Adding to the confusion for consumers, Vicki Veltri, Executive Director of Malta House of Care, says that these fees appear to be set arbitrarily, stating, “It’s not clear from data either that the fees are consistent, or that you could decipher that the fee is consistent for each type of procedure.” 

More and more, independent physician practices have been acquired by hospitals, which leads to consumers being charged for both the physician’s services and for the hospital’s facility fees. Private health plans and hospitals are not required to disclose how these costs are calculated. This partly explains why consumers tend to pay more for medical care after hospitals acquire physician practices, despite no improvement of care or services.

Now, some states are taking action to put an end to this unfair practice, according to Kaiser Health News. Lawmakers in Colorado are considering legislation to limit these fees, which Colorado State Representative Emily Sirota views as predatory. Representative Sirota recently sponsored a bill to ban facility fees for primary care visits, telehealth visits, and certain preventative care services. “Facility fees are simply another way that hospital CEOs are lining their pockets at the expense of patients,” said Sirota.

Besides Colorado, other states that either limit facility fees or are considering restrictions include Connecticut, Indiana, Minnesota, New Hampshire, Ohio, Texas, and Washington state.

CQC urges providers to put an end to absurd facility fees and opaque pricing for patients and encourages insurers to cover needed treatments without sky-high out-of-pocket costs. CQC also calls on lawmakers to take action to stop these predatory practices.