Elmhurst Memorial Healthcare’s new hospital campus hasn’t opened yet, but already some are asking how much it’s going to cost to use it.
“What’s up with the facility fee being charged by EMHC?” one online reader asked Elmhurst Patch. “I have heard other moms talking about [their pediatricians] dropping their affiliation with Elmhurst Hospital because of this fee. Is this true or not?”
The answer is, a facility fee is being charged, but it's nothing new.
Patients and/or their insurance carriers have always paid two types of fees for outpatient physician services. One covers professional costs for time and medical advice. The other is called a facility fee, although it covers more than just office space. It includes nursing staff, clerical support, computer systems, medical supplies and more.
A change in billing practices, however, has made the fee more visible to users, in some cases, said Sheri Scott, EMHC's executive director of marketing and public relations.
“Physicians affiliated with EMHC recently implemented a new hospital-based model of care,” Scott said. “Charges for professional services and facility fees were previously combined into one bill. Hospital-based clinics are required to bill separately for professional and facility fees. This change in billing practices for outpatient physician offices, however, is not at all associated with the new hospital.”
If a patient has insurance coverage, Scott said, these fees are subject to the terms of individual insurance policies.
“An insurance company will either process these two bills as it did when they were billed as a physician office or may process them as an outpatient hospital claim,” she said. “Actually, the one for the physician’s professional services has been reduced because of the change.”
Scott says hospital-based billing is widely used for integrated healthcare services like those at Elmhurst Memorial Healthcare. And since the change took effect in January of this year, it could have fueled speculation about a new facility fee.
“Again, this is not a new fee. It is simply a change from one bill for both professional and facility charges to two separate bills,” Scott said. “There is no fee for using the new hospital, and no providers have severed their affiliations with EMHC because of the move to a hospital-based model.”
Scott says the new hospital-based model of care offers many advantages to patients, including integrated health systems and electronic medical records (especially helpful in emergencies), consistency in delivery of care, high standards for safety and quality of care and state-of-the-art facilities.
The move to a hospital-based model of care for affiliated physician practices allows EMHC to continue to attract high quality providers and make them available to patients, Scott said.
The new facility, at 155 E. Brush Hill Road in Elmhurst, on June 19, and will be open for patient care on June 25.
The "change in billing practices" being, of course, the fact that they are now charging us that fee. A doctor's visit that used to cost a $20 insurance co-pay now costs that same co-pay, plus an additional $50 fee. Why doesn't the insurance company cover the fee? Because most insurance policies don't include coverage of a "Local Monopoly Charge." So, no problem. Just go find another doctor. But not so fast. These guys have medical care pretty neatly locked up for many miles around. What kind of jerk can smile for the cameras and claim there is no new fee here? I'm so happy that the "rumor" started by the bill I received in the mail has now been "dispelled" by our diligent local journalists. I still have to pay it, but at least no nasty rumors are circulating.
I have been in touch with Blue Cross and Blue Shield of ILLINOIS and they are not aware of these changes . I have used the Sciller Avenue facility for years at a 30 dollar co-pay and now they want to change a procedure just to get greedier than they are ... Did you ever go to Lombard and see the facility on Elm and Main Street -- Pretty Nice and Pretty NEW ... What about the sleep center on Main Street in Lombard ??? -- These guys are making money , lots of it , and keep complaining because they are not covering their bills yet they put up the biggest construction project in all of the Chicagoland area last year in Elmhurst ... TIME FOR A CLASS ACTION LAWSUIT !!!
"It seems like a lot of people's insurance [plans] are no longer covering the facility fees" as they did previously and that hospital-owned practices have proliferated, said Richard Gundling, vice president of the Healthcare Financial Management Association, an industry group representing financial executives. The fees could generate an additional $30,000 annually per physician for hospitals.
To Alan Sager, a professor of health policy and management at the Boston University School of Public Health, facility fees are "a tax on sick people" and reflect the "financial anarchy that pervades health care in the U.S." "They are the latest gimmick to generate additional revenue for hospitals," whose profit margins have sagged in the past two years as the economy has nosedived, Sager said. "It's like a barber saying, 'That'll be $20 for a haircut and $10 for sitting in my chair,
Same Building, Different Fee Just figuring out whether a doctor is part of a hospital outpatient clinic can be difficult. While some clinics are distant from a hospital, others are in the same building, sometimes on the same floor as doctors who are not part of such a clinic - and do not collect a facility fee. We need to stop playing these kinds of games," said Mark Rukavina, executive director of the Access Project, a Boston-based research and advocacy group that focuses on medical debt. Rukavina sees the fees as "a tiny sliver" of a major problem facing consumers: figuring out the actual price of medical services coupled with camouflaged cost-shifting that is "gobbling up family resources." In the past two years, researchers have found that the average family deductible paid by consumers has risen sharply - between 30 and 64 percent, depending on the size of the employer. Co-payments, co-insurance and premiums have also spiked.
anger over the fees resulted in a pair of class action lawsuits alleging that hospitals violated Washington state's consumer protection law. Both suits were settled in 2006 with refunds to thousands of patients and a posted price list. The first case was filed after plaintiff Lori Mill was charged $1,133 for a 30-second toenail clipping to check for a possible fungal infection performed by a doctor at a clinic attached to the Virginia Mason Medical Center. Mill said she visited the clinic because it was near her office and was never told about the $418 facility fee until she got the bill. Her plan required her to pay 20 percent of her medical bills. The same procedure at a different Virginia Mason facility, which was not designated an outpatient clinic, would have cost Mill a maximum of $269 - and no fee.
Robert Zirkelbach, a spokesman for America's Health Insurance Plans, the industry trade association, said that although "it's important that patients have information up front" about costs, facility fees have not emerged as an issue for insurers. Young, the plumbing company benefits manager, expects she'll be dealing with them increasingly at her company. She wonders how she'll explain the fees to co-workers, when she doesn't fully understand them. "It's so convoluted," she said. "If I'm confused, how does a normal person figure this out?"
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The patients did not have a choice in this whole new structure and although we did receive a letter, I do not believe that the actual fee it would amount to was mentioned ($84) and from what I read above it appears everyone's fees are different. Almost looks like it is dependent on how much insurance providers are willing to pay. Regardless of whether my deductible is met or not I find this practice to be unethical. What they are doing is charging their office visit patients to pay for their new hospital. Then they have the audacity to send me letters asking for donations. If I had millions (billions) this would be the last place I would donate to. This sickens me and someone in power needs to fight for our rights. Shame on the doctors who agreed to stay on and be part of this practice.