The Ongoing Fight Against Healthcare Sticker Shock

The Ongoing Fight Against Healthcare Sticker Shock

Most of us have, at one point or another, experienced “sticker shock” when we opened a medical bill – no matter how knowledgeable we might consider ourselves, as it pertains to the healthcare industry. And for those who don’t work in healthcare, it can be even harder to feel confident that you’ll be charged what you’re expecting. President Biden recently announced a series of newly proposed rules and initiatives by his Administration that aim to tackle increasing costs and unexpected fees in the healthcare industry, with the stated goal of preventing Americans from being, quote, “ripped off,” and left unable to achieve the American Dream.

The Administration highlighted three new healthcare actions in particular: scaling back the previous expansion of short-term health insurance plans, protecting consumers from medical credit cards and loans, and further preventing surprise medical bills. Let’s take a closer look at this last category.

While frequent Monitor Mondays listeners have certainly heard the “Legislative Update” feature the No Surprises Act (NSA) a time or two, the Biden Administration clarified that it is now focusing on some “loopholes” that have cropped up under the NSA, leaving Americans again vulnerable to unexpected charges. One of the lesser-known types of surprise bills consumers have seen more of in the last few years are facility fees. 

Facility fees were originally charged by hospitals, meant to offset the extra costs of maintaining, as you might guess, the actual facility. But now people are starting to see them tacked on to bills from their regular doctor, urgent care clinic, or outpatient medical or surgery centers – and sometimes even their telehealth bills, due to the fact that more and more physicians are now employed by hospitals or health systems. These fees have grown quickly in recent years, with studies showing an average increase of 531 percent from 2004 to 2021. Insurers are hesitant to cover these fees, often leaving the patient exposed to the charge in part or in whole.

Proponents of the fees state that they allow hospitals to spread out the costs of maintaining expensive facilities and units (like ERs), keep those facilities well-equipped and staffed 24/7, and help cover the losses of patients who are unable to pay their bills (in short, they say limiting these fees could negatively impact patient care). Opponents, which certainly includes patients who have received an unexpected facility fee, have expressed the belief that these fees are simply padding hospital budgets – they have told of their horror not only at the fee amount but that they were often unaware a facility fee would be charged at all.

President Biden made sure to note that the main target of his initiative is addressing that “surprise” aspect of these charges, rather than eliminating them altogether. But some states have taken a stronger approach. Connecticut, Colorado, and Texas all proposed legislation this year to limit facility fees for certain services, while five other states across the country have either already passed or are considering such legislation. The National Academy for State Health Policy has released model legislation for states to consider that prohibits facility fees for services rendered at locations more than a certain distance from a hospital campus, andrequiring annual reporting of fees charged.

While the future of facility fees is unclear, it’s certainly an issue that is worth a closer look. Recent estimates indicate that almost half of patients in the healthcare industry have received a bill with a facility fee – far more even than those hit by traditional surprise bills. So as both D.C. and states begin to investigate the issue, we can likely expect it to move further into the spotlight in the coming months.

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn

Cate Brantley, JD

Cate Brantley is a legislative analyst for Zelis. She has over 9 years of experience in both the public and private sector. Cate is licensed to practice law in the state of Oklahoma.

Related Stories

New Approach to Medicare Part D

New Approach to Medicare Part D

In a significant overhaul of Medicare Part D, set to take effect in 2025, beneficiaries are poised to experience a transformative change in how prescription

Read More

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Frank Cohen shows you how to leverage the Comprehensive Error Rate Testing Program (CERT) to create your own internal coding and billing risk assessment plan, including granular identification of risk areas and prioritizing audit tasks and functions resulting in decreased claim submission errors, reduced risk of audit-related damages, and a smoother, more efficient reimbursement process from Medicare.

April 9, 2024
2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Explore the top-10 federal audit targets for 2024 in our webcast, “Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets,” featuring Certified Compliance Officer Michael G. Calahan, PA, MBA. Gain insights and best practices to proactively address risks, enhance compliance, and ensure financial well-being for your healthcare facility or practice. Join us for a comprehensive guide to successfully navigating the federal audit landscape.

February 22, 2024
Mastering Healthcare Refunds: Navigating Compliance with Confidence

Mastering Healthcare Refunds: Navigating Compliance with Confidence

Join healthcare attorney David Glaser, as he debunks refund myths, clarifies compliance essentials, and empowers healthcare professionals to safeguard facility finances. Uncover the secrets behind when to refund and why it matters. Don’t miss this crucial insight into strategic refund management.

February 29, 2024
2024 SDoH Update: Navigating Coding and Screening Assessment

2024 SDoH Update: Navigating Coding and Screening Assessment

Dive deep into the world of Social Determinants of Health (SDoH) coding with our comprehensive webcast. Explore the latest OPPS codes for 2024, understand SDoH assessments, and discover effective strategies for integrating coding seamlessly into healthcare practices. Gain invaluable insights and practical knowledge to navigate the complexities of SDoH coding confidently. Join us to unlock the potential of coding in promoting holistic patient care.

May 22, 2024
2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

HIM coding expert, Kay Piper, RHIA, CDIP, CCS, reviews the guidance and updates coders and CDIs on important information in each of the AHA’s 2024 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.

April 15, 2024

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

Happy World Health Day! Our exclusive webcast, ‘2024 SDoH Update: Navigating Coding and Screening Assessment,’  is just $99 for a limited time! Use code WorldHealth24 at checkout.

SPRING INTO SAVINGS! Get 21% OFF during our exclusive two-day sale starting 3/21/2024. Use SPRING24 at checkout to claim this offer. Click here to learn more →