Vail Daily column: New ‘facilities fees’ could hit patients |

Vail Daily column: New ‘facilities fees’ could hit patients


There could soon be a new medical fee. Would you be upset with an increase in your medical out-of-pocket costs? Across the county, there is a new fee we may find we are being charged in addition to our doctor’s bill. This new fee is called a “facility fee.” A facility fee is charged for services given in a hospital-based outpatient clinic or location. With the proliferation of hospitals buying medical practices and the consolidation of hospitals, patients are getting hit with exorbitant added costs.

In addition to the facility fee, here is a list of health insurance terms many of us are already familiar with:

• Premium: The monthly fee for your insurance.

• Deductible: How much you must kick-in for care first, before your insurer pays.

• Co-pay: Your cost for routine services to which your deductible does not apply.

• Co-insurance: The percentage you must pay for care after you’ve met your deductible.

• Out-of-pocket maximum: The absolute max you’ll pay annually.

Understanding these insurance terms and knowing how each of our medical payments are applied will assist us in keeping unforeseen charges at bay.

In an effort to mitigate the ever-increasing cost of our medical insurance, many people are choosing higher deductible health plans. However, there is a downside to this. If you become very ill, you will quickly understand why it’s called a high-deductible plan. Facility fees are not nominal, and they come out of our pocket. This fee is in addition to all the other costs we must pay until we reach our out-of pocket maximum.

With the emanate facility fee coming our way, it is important that we educate ourselves with how these fees will affect us and what options are available to us. It is going to be our responsibility to ask our medical providers if procedures they may recommend for us may have this associated charge imposed.

Some of the common surgical procedures that are now incurring the facility fee include: drawing blood, non-stress fetal tests, skin biopsy tests, larynx and throat tests called a laryngoscopy test, colonoscopy test, synovial fluid aspiration test called arthrocentesis, endoscopy test which are used to examine a person’s digestive tract and most procedures which are used for treatment for skin cancer. These are only a few of the tests which may incur these new fees.

In order to understand the full impact of what our financial responsibility may be, it is important that we communicate with our insurance company once our medical providers identify procedures that may incur added costs. How do you know which procedures may incur these fees is a great question. Asking your medical provider, their billing department and the hospital prior to the procedure is a good start.

Most often, facility fees are billed to patients as a separate bill. However, this is not always the case. Sometimes, we may find that we will pay more for certain outpatient services and procedures at hospital-based outpatient locations. The amount will depend on our insurance policy and provider.

Many of the hospitals that charge a facility fee believe the fees are justified because the fees help spread the cost of maintaining expensive units such as 24-hour emergency rooms and costs incurred by patients who can’t pay their bills.

Regardless of where you live, if you ever find yourself in front of a hospital admissions person who tells you that you will get two bills instead of one, you should not let this just pass by as a procedural statement. Rather, you should sit at the end of your seat and start asking questions — lots of questions.

Judson Haims is the owner of Visiting Angels Home Care in Eagle County. You can contact him at and 970-328-5526.

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