Patients face unexpected facility fees as hospital ownership drives billing confusion.
A growing number of patients are getting hit with fees they didn’t expect when they visit medical offices tied to hospitals. These extra charges, called facility fees, often come as a surprise. In many cases, they are higher than the cost of the doctor’s time or treatment. What once was a straightforward bill has become harder to understand, and people are left confused, frustrated, and sometimes unable to afford care they need.
One woman in Ohio received a cortisone shot at a clinic connected to a large hospital system. The visit lasted less than ten minutes. When the bill arrived, she saw a separate charge labeled as a facility fee—more than $2,400. A month later, a similar visit led to another large charge. When she questioned the fees, the hospital told her they forgot to bill her for an earlier visit and sent a new charge for that one too. She contacted government offices, regulators, and consumer agencies, but none could help.
Facility fees aren’t new, but they’ve become more common. This has happened at the same time that hospitals have been buying up doctors’ offices. When that happens, the location gets reclassified as part of the hospital system. That change allows the facility to add an extra fee on top of the doctor’s charge, even if the care provided stays the same. The extra cost can apply to shots, consultations, or simple checkups.
Some experts believe this trend is leading to an uneven system. Charges seem to vary without clear explanation, and patients often don’t know what they’ll owe until after the fact. Critics argue that many people aren’t aware that a regular appointment could carry hospital-level fees simply because of who owns the building or manages the paperwork.
So far, there are no national rules to control how these fees are used. A few states have started passing laws to push back. In Ohio, for example, lawmakers banned facility fees for telehealth visits where the patient never enters a building. Other states are working on making bills clearer or setting limits on what can be charged. Still, the rules are scattered and don’t fully address the issue for most in-person care.
Health systems defend the practice by pointing to extra costs tied to equipment, safety standards, and building operations. They say the fees help keep clinics running and allow them to meet industry standards. But these explanations haven’t satisfied patients who see little connection between what they paid and what happened during their visits.
Some health policy groups are looking at a different approach. One idea gaining traction is called “site-neutral payments.” That means a single price would be set for a medical service, no matter where it’s given. A shot in a doctor’s office and a shot in a hospital clinic would be billed the same. Supporters believe this would stop large systems from charging more simply because of ownership or location.
So far, hospitals and national associations have stayed mostly quiet. They’ve issued written statements but haven’t agreed to speak directly with reporters. Meanwhile, patients continue to face unexpected charges and make tough decisions about whether to seek care. Some now hesitate to go to appointments, fearing what the bill might bring.
Even when patients push back and manage to get fees lowered, the problem doesn’t go away. The larger issue is that prices can seem random and hard to fight. Without broader change, many people will continue to find themselves in the same position—staring at bills they didn’t expect, wondering how things got so out of hand.
Sources:
What’s a facility fee? About that mysterious number on your medical bill.
Beware of Surprise “Facility Fees” Medical Bills
What does a ‘facility fee’ mean on a medical bill? What to know
The Rise of Hospital Facility Fees & Their Impact on Patients
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