With health care costs already strangling many families, a lawmaker wants to make sure Pennsylvania residents aren't surprised by the controversial fees that have angered some Lehigh Valley residents.
Rep. Dan Frankel introduced legislation about a week ago that would require hospitals to tell patients in advance if they will be charged "facility fees" for visits to hospital-owned outpatient facilities, including doctors' offices.
I warned you about facility fees last year after hearing from patients at Coordinated Health who questioned them. They had gone to see their physicians and were billed twice — once from the doctor and then from Coordinated Health, which owns the buildings where the doctors have their offices.
The patients wondered why they were charged hospital fees when they hadn't gone to the hospital. The answer is, federal law allows hospitals in some cases to charge hospital fees for visits to outpatient facilities they own, too.
Ken Clauser of South Whitehall Township had complained about getting a facility fee bill of $202 from Coordinated Health for a visit to his doctor. That trumped the $135 he was charged by his physician. His insurance covered some of the cost but not all of it.
Frankel, a Democrat from Allegheny County, said he's seen more extreme examples.
In a memo to other legislators last year, he said a constituent had a $145, five-minute, skin tag removal in a doctor's office in a hospital-owned building and was charged a $705 facility fee for "operating room service."
I haven't seen anything like that locally.
"In our changing economic climate, patients are being asked to pick up more of their health care bills straight out of their pocket," Frankel said in a statement. "We simply can't expect patients to be savvy health care consumers without giving them the tools to make smart health care decisions."
Coordinated Health already is telling people they will be charged facility fees, said Dr. Emil DiIorio, president and CEO.
He told me his hospital's outpatient facilities must meet hospital-quality standards for safety and patient care, and the fees cover the cost of making that happen.
"Facility fees help us provide the necessary infrastructure to reach as much of the population as possible with the same high-quality standards of care," DiIorio told me in emailed answers to my questions.
Coordinated Health patients told me they've been told the fees cover things like medical equipment, exam rooms and clerical staff.
I checked with Lehigh Valley Health Network and St. Luke's University Health Network and was told they do not charge hospital facility fees for treatment in outpatient facilities.
Frankel questions the legitimacy of the charges. He told me it makes no sense that one person who visits his doctor isn't charged a facility fee because a hospital doesn't own the building, while another person who sees another doctor for the same treatment in a hospital-owned building is charged a fee.
"You're not getting better service. You're not getting better health care," Frankel said. "You're just paying more for the same thing because of a reclassification of the same facility."
While they can't stop the fees because they are permitted by federal law, Frankel and his co-sponsors, including Rep. Mike Schlossberg of Allentown, are trying to empower patients to avoid them or at least prepare to pay them.
The legislation, House Bill 1625 would require hospitals to disclose whether they charge the fees and the amount of the fees. Hospitals also would have to tell patients whether any of their other facilities provide the same care without charging a fee.
Schlossberg, a Democrat, told me he hasn't received complaints about facility fees but he signed on to the legislation because it's a fairness issue. He said fees should be disclosed so people can determine if they can get treatment at a lower cost elsewhere.
DiIorio told me Coordinated Health patients are advised of the fees through signs posted at check-in and through papers they must sign acknowledging billing policies.
"While health care is a complex and at times confusing system, we believe in transparency," DiIorio said.
He said the amount of the fees is not available prior to treatment, though, because the amount depends on the level of care provided, which can't be predetermined.
Federal regulations already require some notifications about facility fees but from what I can tell from trying to decipher the bureaucratic-written rules, that applies only to Medicare beneficiaries.
Several of the Coordinated Health patients I heard from last year told me they hadn't been notified. They said they support Frankel's plan to prevent bill shock.
Clauser told me people should know in advance what kind of charges to expect so they can factor cost into their health care decisions.
He said his wife has switched doctors to avoid being charged facility fees at Coordinated Health. Clauser hasn't switched and continues to be seen in a Coordinated Health facility knowing that he'll be billed by both the hospital and his doctor.
"I like the doctor," he told me. "Where would I go to find another doctor that I like as well and who has my history?"
That's his choice to make. State lawmakers should make sure people are given the information to make those kinds of informed decisions.
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