#they're called 'outpatient appointments' that i'm being charged for | Explore Tumblr Posts and Blogs

takecharge · 5 years

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The health care costs you weren't expecting

Tl:Dr - fees can be hundreds of dollars that you have to pay for every office visit or test at a medical center. Do your homework before choosing a doctor to find out if you will be paying these fees out of pocket.

Two years ago at my job a new chat room was started. It was called Insurance Issues. In the span of two weeks three people at my job were charged an extra $300 dollars for routine medical tests at our local hospital. One was a simple blood test. I moderated the chat room because I was one of them, and I'd done the work to figure out where these fees were coming from.

What are facility/hospital fees

The charges were facility or hospital fees. The word hospital may be misleading here, if you go to a medical center, these may also apply. They are a surcharge you can be charged for simply being at a hospital or larger care facility when you see a doctor or get a test done. They can be charged even if the hospital lab is in-network for your insurance. And in some cases even after you've paid your deductible, these are out of pocket costs.

Where you can go to get cheaper tests

The insurance company would rather you go to get your tests done at a testing facility like Quest Diagnostics. These places offer far cheaper rates and for some people going to them it's not that much of an inconvenience. But none of the people at my company, nor HR, knew that. We'd watched the webinar at the beginning of the insurance term and hadn't walked away realizing we had homework to do every time we needed a blood test.

We were all confused. In the large city I live in even PCPs are usually part of a hospital network. When we read the patient information materials the hospitals in question were in-network. The document stated that any outpatient labs were covered for any in-network locations. Only when we looked up each test in the document did we find that the insurance would pass any extra costs like facility fees on to us.

I had already been fighting the insurance company for months so I had the person whose job it was to make me stop calling on speed dial. I walked her through the materials and she agreed that they were extremely misleading. Eventually the $900 we paid got waived. I'm pretty sure the next year those documents were written differently.

Cost estimators will help you make a choice to lessen or prevent these charges

Insurance companies in the US have websites and often apps that exist just to help you figure out what charges you might be on the hook for. Get to know them before you need them. Look up an ankle x-ray and you'll be able to see based on the facility how much it will cost you. I recently did this when I knew I needed an ultrasound. My out of pocket costs ranged from nothing at a hospital over an hour away to $300 from the hospital where my specialist works. When I factored in the cost of transport to and from the other hospital, the $300 didn't look too bad, but I also had another strategy in mind.

Sometimes where the test is done changes the billing

I'd learned before my last surgery that blood draws done in my doctor's office, instead of the lab downstairs. The charge numbers are different, so the hospital fees didn't apply. I asked my specialist if the ultrasound might be the same story and if possible could we do it in his office. I got it done in the office and didn't get charged the hospital fee.

Office visits can charge hospital fees too

When looking for a provider, I would recommend contacting the billing department where they are located and asking if a facility fee is charged for office visits. My new pain specialist is at a facility that does charge this fee and I've decided to pay it. The clinic is a good one and it's worth it to me. I also can afford it until I've paid my deductible, at which point my insurance will pay it.

Insurance companies think they've given you enough information

When I saw the facility fee for a routine office visit, I called the claims department at the insurance company to find out if this was the new normal since I'd never been charged one for an office visit before. The woman on the phone said it's becoming more common for hospitals to bill this way. We chatted about my concern that many patients are going to be blindsided by this. She commiserated. She and her colleagues have to explain these bills daily.

To be totally honest, the insurance companies are trying to be more transparent. That's why the cost estimators exist. The materials insurees get every plan year do recommend using the cost estimator so you don't get unexpected bills. But most people who have insurance won't use the estimator. They go to the doctor maybe twice a year and when they're injured. Preventative care appointments are usually covered at 100%. And the last thing you're going to do when you break your ankle is consult the estimator before deciding which hospital to go to.

The people these estimators help the most are those of us who are already insurance savvy. We know we better check for unexpected fees. So do your friends and family a favor and make them read this post or articles on the same issue. Be the person who asks about this at the webinar even if the presenter went over it (because your colleague that was playing a game on her phone will probably pay attention to your question because she's frustrated you're making this boring meeting go longer).

Just like ballooning mortgage bills these fees are things even well people need to know about. I just had this discussion with my parents and colleagues and they were convinced they didn't need to know this until I spelled out the potential costs.

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