Chethan Sarabu, MD
Nov 1, 2024
Imagine this: you receive a medical bill and find a list of unexpected charges that have driven the cost much higher than you planned. These added expenses are often due to hidden fees that, while sometimes legitimate, can catch patients off guard. Knowing what these fees are and how to spot them can save you both money and confusion.
Common Hidden Fees to Watch For
1. Facility Fees
Hospitals and clinics may charge a “facility fee” simply for using their building and resources. While the fee is intended to cover maintenance and other infrastructure costs, it’s often added on top of the provider’s service fee, even for outpatient or telehealth visits.
Example: You might visit a hospital-affiliated clinic for a routine check-up, only to find a $150 facility charge on top of the doctor’s fee.
2. Out-of-Network Charges
Even if you go to an in-network hospital or clinic, you might be treated by out-of-network providers—like an anesthesiologist or radiologist—which can lead to unexpected charges. The No Surprises Act which went into effect in 2022, has reduced many of these surprise bills by protecting patients from unexpected out-of-network fees in emergency situations or when receiving care at in-network facilities. However, some charges may still apply if the service doesn’t fall under the Act’s protections or if the patient consents to out-of-network care in advance.
Example: A patient undergoes surgery at an in-network hospital but receives a separate, costly bill from an out-of-network anesthesiologist who assisted during the procedure.
3. Separate Fees for Tests and Procedures
Routine tests or screenings are sometimes charged as separate services, even if they were recommended as part of a regular check-up or procedure.
Example: Your doctor orders a blood test during your annual physical. Instead of being bundled with the appointment cost, the test appears as a separate line item with an additional lab processing fee added.
4. Pharmacy or Medication Administration Fees
When patients are given medications in hospitals, they may receive an added fee for administering those drugs, even if they’re covered by insurance.
Example: A patient receiving an IV antibiotic during a hospital stay sees a separate “medication administration fee” alongside the cost of the medication itself.
Why Are These Fees Hidden?
Healthcare billing is notoriously complex and certain charges may not be clearly labeled on a bill. Some fees are bundled together as vague line items, while others may be separated out, making it hard for patients to tell if they’re necessary or fair. Additionally, because medical bills can span multiple pages and include various providers, fees like these are often lost in the fine print or listed in a way that doesn’t clearly explain their purpose.
How to Spot and Challenge Hidden Fees
While hidden fees may feel inevitable, there are steps you can take to spot and challenge them:
1. Request an Itemized Bill
Start by asking for an itemized bill from your healthcare provider. This document lists each service and fee separately, making it easier to identify anything unexpected.
2. Verify Services with Your Insurance Provider
Compare the charges on your bill to what’s listed on your Explanation of Benefits (EOB) from your insurance provider. Confirm with your insurance which charges are covered and which you may be responsible for.
3. Contact the Billing Department for Clarification
Reach out to the billing department of the provider’s office to clarify any vague or unexpected charges. Billing representatives can often explain fees and may adjust errors.
4. Negotiate or Request Adjustments
You may be able to negotiate the charges. Many providers are willing to work with patients, especially for fees like facility or administrative charges that may be flexible.
The More You Know
Hidden fees can make healthcare costs feel like a guessing game. Facility fees, out-of-network charges, and separate fees for routine tests can quickly add up, putting an unexpected strain on your finances. By knowing what to watch for and understanding how to request clarity on your bills, you can help protect yourself from hidden fees and gain more control over your healthcare expenses. Next time a bill arrives, take a closer look, ask questions, and don’t be afraid to negotiate—your wallet may thank you.