You’ve probably seen it before: a high bill after a medical appointment, sometimes the result of a “hospital fee” or “facility fee.” Now, some patients are seeing them on bills even when they never set foot in a hospital.
These fees, intended to cover hospital operating costs and staff, are appearing more frequently in outpatient settings as hospital systems acquire provider offices.
“I noticed it was a little high,” said Brian, who asked us not to use his last name. “Looked at the breakdown, and had seen, ‘Oh a hospital fee.’”
Brian was surprised — he hadn’t visited a hospital. He visited a medical specialist at a clinic he had visited for years.
“$190, that’s like somebody’s electric bill for a month at home,” Brian said. “I wonder how many people they’re actually doing this to, without them even knowing that that’s happening.”
Patricia Kelmar, Senior Director of Health Care Campaigns at the Public Interest Research Group (PIRG), said more patients are seeing them at regular doctors for checkups.
“The reason that’s happening is that more and more hospital systems are purchasing provider offices,” she said. “They’re purchasing our local oncology practices or OBGYN practices.”
Kelmar said the fees can vary: $50 for some, a few hundred dollars for others. In some cases, Kelmar has seen patients billed over $1000.
PIRG wants state lawmakers to ban the fees in outpatient settings.
“These folks are going for their regular checkups, right? They’re not using any of the hospital services, and yet, the hospitals are sending a separate bill charging for the overhead costs of running a hospital in their community,” Kelmar said.
Kelmar said she’s spoken with patients who have told her they now “think twice” to even visit their doctor for an annual checkup, because “they just don’t how much extra it will be.”
Washington currently bans facility fees on audio-only telehealth appointments, but they are legal at outpatient clinics, so long as patients receive notice and the fees are reported to the state.
UW Medicine in Seattle, for example, reported bringing in more than $14 million in revenue from facility fees during fiscal year 2024. Similarly, EvergreenHealth in Kirkland collected over $18 million in facility fee revenue in fiscal year 2024.
KIRO 7 reached out to both hospital systems to inquire about where the money goes.
UW Medicine told us that facility fees reflect “real infrastructure costs” that support “high-quality clinical care.”
“Essential costs we cover include around-the-clock staffing for nursing, medical assistants and administrative personnel; X-rays, lab tests and therapies, physical plant upkeep including utilities and safety infrastructure; electronic health record systems; biomedical equipment maintenance and calibration; and sterile supply chains,” a spokesperson for the medical system wrote. “Hospital-owned facilities also bear the cost of maintaining these capacities to serve all patients regardless of their ability to pay.”
Seattle Children’s reiterated a similar message: the medical system cares for “all patients regardless of their ability to pay.”
A spokesperson for the hospital told KIRO 7 that Seattle Children’s uses facility fees to support services provided at both hospitals and outpatient settings, noting those outpatient clinics are “equipped and staffed to care for medically complex and high-acuity pediatric patients, including those requiring specialized equipment, enhanced clinical support, and access to hospital-based resources.”
“Revenue from facility fees supports Seattle Children’s ability to maintain these specialized pediatric outpatient services and helps offset the significant gap between reimbursement and the cost of providing care,” a spokesperson wrote. “Last year, Seattle Children’s provided approximately $272 million in uncompensated and undercompensated care to help every child we care for live the healthiest and most fulfilling life possible.”
EvergreenHealth told KIRO 7 its outpatient clinics are called “hospital-based departments” that include advanced facility space and medical technology.
“Facility fees cover EvergreenHealth’s costs associated with the building where care is provided, supplies, medical equipment and the support staff necessary to deliver enhanced coordination of care,” wrote EvergreenHealth Chief Financial Officer Bill Howe. “We are dedicated to providing the best care possible for our patients as well as creating a better understanding of the cost of care, including the driving forces behind current cost increases and shrinking reimbursement rates from insurance companies for the care we deliver.”
Patients can take several steps to understand and potentially negotiate these charges.
Experts recommend always requesting an itemized bill from the provider to review each charge. Additionally, patients should contact their insurance provider to confirm if these fees are covered under their plan and if they are permissible charges. This information can then be used to negotiate the bill directly with the clinic.
Some plans will cover some or all of the charges, but others will not.
PIRG has compiled more tips to save you money when you’ve identified a mistake on your medical bill here.
The organization is actively collecting data on these fees from affected patients. Individuals who have been charged a facility fee are encouraged to contact the organization here.
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