Healthcare costs are rediculous, with patients being made responsible for high deductibles before their insurance pays anything.
Seeing your primary care doctor is usually an affordable thing to do, especially as many of them are forced to compete with the walk-in clinics that seem to be proliferating everywhere.
Wall Street is even getting into the game aggregating money to buy practices and then charging outrageous fees for ER visits since they now own the group that supplies the doctors who work in many hospitals. My friend who is an anesthesiologist recently left his group at Barnabus because the wall Street financed group who purchased his practice was working him harder than ever, leaving little time for a personal life. He recently relocated to JFK hospital which still has a doctor-owned group. Many of these Wall Street financed purchases only see dollar signs.
Hospitals are buying practices and specialty groups as well with the same goal in mind; to generate more income. It has been estimated that a single primary care physician who is employed by the hospital and is making $220,000 per year will generate 10x that amount in services for the hospital that employs them or owns their practice, while the doctor no longer needs to worry about billing and other administrative headaches.
This is good for the hospital’s finances and is the reason so many hospitals are purchasing practices, while new graduates are more likely to work for a hospital or a group.
From the patient’s point of view, a regular office visit may cost them a co-payment. Hospitals and larger groups have negotiated higher fees for the work their physicians do, which is one of the reasons so many physicians are moving into this model. Doctors in private practice are being paid less, while larger systems are being paid more. This is a side effect of the insurance model and has resulted in reduced competition and choice for patients.
If your doctor sees you for a regular visit and performs a procedure, you may find yourself being charged an outrageous facility fee. This fee can be hundreds to thousands of dollars and can go toward the deductible part of your insurance even though your visit should have only cost you a co-payment. This happened to my wife years ago when she used to visit a doctor who she participated with under a monitoring program run by Sloan Kettering. She went for her regular 10-minute visit and the doctor saw something and then did a quick scrape and sent it to the hospital’s lab. A few weeks later we got two different bills, one for a facility fee and the other for a surgical procedure with things that were never done. All told, the two bills were over $4500 for the preventative 10-minute screen. I challenged the bill and offered a reasonable settlement for the visit which the hospital refused. After a year and a half of communications to my carrier and to the hospital’s collection agency, the collection agency and the hospital eventually relented after I proved repeatedly my wife was overbilled. The process required me to be as relentless as they were. It has now become common for hospitals to sue patients because so many plans now have high deductibles.
Doctors who are hospital-based do not control their billing and have no idea how any of this works, as they are employees. The NY Times recently asked the question of “why was that doctor visit so expensive?” Of course, the facility fee which is a fee hospitals can charge for the use of their offices by the doctor you visited is usually the reason. There are no laws protecting the public from this nonsense. Check out the article below
Why Was My Doctor Visit Suddenly So Expensive?
The facility fee may be to blame for the added costs of a doctor visit.
By Richard Klasco, M.D.
Published Nov. 1, 2019
Q. I was recently charged a “facility fee” for seeing my doctor, doubling the cost of my visit. What is the facility fee?
A. A facility fee is an additional charge that some medical practices can add to the cost of each doctor visit. The additional charge usually comes as a surprise because, unlike an exam or a test or treatment, the facility fee is not tied directly to hands-on care.
The purpose of the facility fee is to compensate hospitals for the expense of maintaining the physical premises. Hospital-owned, off-campus medical practices are also allowed to charge the facility fee to cover specific regulatory requirements, such as building codes, disaster preparedness, equipment redundancy and other items that are largely invisible to patients.