HOUSTON – Unexpected, unexplained fees are driving up the cost of doctor visits for families across Houston. We are talking hundreds of dollars in charges above your co-pay. They’re called “facility fees,” and patients are told days or weeks after their appointments they have to pay up.
“It’s absolutely outrageous,” said Mindy Easterbrook.
Outrageous new charges that Easterbrook has never been charged when she takes her two children with Type 1 diabetes to see their doctor.
“They see an amazing doctor there. We absolutely love her, but we’re getting charged facility fees now by Texas Children’s Hospital on top of our regular doctor fees that we’re being billed,” said Easterbrook.
One $290 item on her bill is labeled “observation/treatment room.” Another fee of $405 says it’s a “room, staff and supply charge.”
Texas Children’s Hospital told Easterbrook she will incur these fees at every visit with her children’s endocrinologist where her daughter and son check in every 3 months.
“For these facility fees, you don’t get a choice. You can’t opt-out. You don’t know what these fees are going for,” said Maribeth Guarino.
Guarino has studied facility fees as a healthcare advocate for the U.S. Public Interest Research Group Education Fund or “PIRG” for short.
She says facility fees are common at hospitals where patients are billed separately for doctors, specialists and room charges. But in recent years as hospital systems buy up doctor’s offices, they are adding these facility fees to regular doctor bills.
RELATED: What is a facility fee?
When did Hospitals in the Houston area start charging facility fees?
Texas Children’s Hospital told KPRC 2 it began adding the fees to its doctor’s offices that it considers “hospital-based clinics” on November 1, 2023.
“Right now, these outpatient departments that hospitals own are licensed under the same number as the hospital and so that’s how they kind of get away with “it’s a hospital location” even though the location might actually be 2-10 miles away from the actual campus of the hospital,” explains Guarino.
Other viewers have sent us their bills showing their own fees. One viewer’s bill shows a $200 facility fee. In their case Blue Cross Blue Shield paid $74 leaving the patient owing $126 above their co-pay.
While the chatter is largely from Texas Children’s patients locally, other hospitals here and across the country are charging the same type of fees.
Methodist, Memorial Hermann and MD Anderson all confirmed with KPRC 2 News that they also charge facility fees to patients visiting doctors outside of their traditional hospitals.
15 states have passed laws limiting the fees in some way but only Connecticut has banned facility fees for non-emergency, outpatient care.
Federal lawmakers are currently working on the ‘Lower Costs, More Transparency’ Act. If passed by both the House and Senate, it would end facility fees outside of traditional hospitals.
Until then patients like Hunter, Skye and their mom don’t have a choice.
“Our kids come first. We have to have them seen,” said Easterbook.
“Patients cannot be on the hook for these charges especially when they’re already struggling to pay and delaying care because they’re afraid of the cost,” said Guarino.
What can I do about facility fees on my medical bill?
So, what can you do about these facility fees? We know that many patients have had those facility fees waived as a one-time courtesy when they called the TCH billing department.
A Texas Children’s spokesperson also told me that telehealth visits and urgent care visits will not incur facility fees.
That federal bill before the U.S. Senate appears to have bipartisan support. You can reach out to your senator if you want them to ban these fees.
The Texas Hospital Association told KPRC 2 News the fees are necessary. They sent this document that explains that hospitals would have to reduce staff, cut services, and close outpatient clinics if these fees are banned.
KPRC 2 News reached out to several of the larger hospital systems in the Houston area to see if they charge facility fees. Find the full statements below.
Texas Children’s Hospital
Over 70 years ago, Texas Children’s was founded on the guiding principle that every child deserves the highest quality care regardless of their family’s ability to pay. Since then, navigating healthcare has become increasingly complex, but we remain resolute that cost should never stand in the way of our patients receiving the care they deserve. If any of our patients are struggling to either understand their bill or need financial assistance, we have a wonderful team dedicated to assisting them every step of the way. We are fully committed to meeting patient families where they are at and assisting them with any challenges or questions they have.
Why did TCH decide to add the facility fee so that they appear on a patient’s bill after what they believed were regular doctor office visits?
Texas Children’s follows the appropriate guidelines when billing health plans for the services rendered on behalf of a patient. It is important to understand that a patient’s out of pocket expense is determined by the assigned benefits within their individual health plan and not by Texas Children’s.
How can patients know when they will see this fee on their bill before they book an appointment?
Texas Children’s is fully committed to price transparency with our patients and offers a number of ways for them to receive a pre-visit estimate ahead of time.
*It is also important for patients to know that if patients schedule a TeleHealth visit or a visit at a Texas Children’s Pediatrics or Urgent Care location, the visit will not include a facility fee charge as that charge is only applicable in a hospital-based location.
Is there a way for patients who see the same doctor for routine visits (monthly visits, for example) can appeal so that they are not paying the facility fee with each appointment?
The facility fee is applicable to each individual visit in a hospital-based location until a patient meets their insurance deductible, after which the fee for each visit will transition to the co-insurance rate predetermined by the patient’s health insurance plan.
Houston Methodist
Houston Methodist does not charge facility fees at its physician-based clinics. There are a few hospital-based clinics where a facility fee is charged such as the transplant clinic, wound care clinic, radiation oncology clinic and the infusion clinic. Facility fees help hospitals offset the higher cost of providing specialty outpatient services to patients allowing us to provide a higher level of care that is safe and convenient for our community.
Billing FAQ from Houston Methodist
MD Anderson
MD Anderson facilities are hospital-based locations offering multidisciplinary hospital-level care in the outpatient setting, which requires specialized staffing and infrastructure. MD Anderson provides patients with one financial statement, which includes both physician and hospital charges, but these may be processed differently by a patient’s insurance. This information is shared with all new patients and is available online. Patients with questions can contact MD Anderson’s Patient Business Services for clarification.
Memorial Hermann
“Memorial Hermann has approximately 90 hospital outpatient departments across the system. These are not doctor’s offices. They are outpatient departments of the hospital that provide highly specialized services. In outpatient departments with a physician-led care team, the physicians are not employed by Memorial Hermann. In compliance with regulatory requirements, patients are provided notice that they are receiving care in an outpatient hospital department and the physician’s billed services will appear separately from the hospital payment. These hospital payments (also known as “facility fees”) cover all of the other essential aspects of care including nurses, lab technicians, technology and other functions – services for which the hospital would not otherwise be paid. Memorial Hermann does not bill facility fees from any of its primary care clinics.
Offering complex care in an outpatient setting means that care is more affordable and more convenient for patients to access, and these hospital payments enable us to effectively partner with physicians to provide that care. We also know that navigating health care costs is complex, so we offer patients access to resources like our good faith price estimate tool so they can make well-informed decisions about their care.”
Billing FAQ from Memorial Hermann