Representatives of North Carolina hospitals and health insurance plans faced off this week over the lingering dispute over fees hospitals sometimes charge patients treated in clinics or doctor’s offices.
State senators have pushed for limits on the charges called “facility fees,” concerned that they contribute to inflated medical bills.
The Senate passed a bill unanimously last year that would allow facility fees to be charged only when patients are treated at hospitals, facilities with emergency departments, or ambulatory surgical centers. Hospitals would no longer be able to add the fee to clinic or doctor’s office bills.
Senate Bill 316 has been stuck in the House Rules committee, and has not received a hearing there.
Peter T. Daniel, executive director of the N.C. Association of Health Plans, told members of the Joint Legislative Oversight Committee on Health and Human Services this week they are right to look at restricting the charges. The Senate bill would reduce health care costs by an estimated $200 million a year, he said.
Facility fees were originally designed to support around-the-clock hospital operations, Daniel said, but they’re being charged to patients who aren’t treated in hospitals.
“Patients are being charged facility fees for routine care delivered in hospital-owned outpatient offices — offices that operate during normal business hours and look no different than the independent practices next door,” he said.
He pointed to reports of cases where facility fees dramatically increased bills, including a 2021 report in the Charlotte Ledger about a man charged a $5,300 facility fee when he had a colonoscopy at a hospital-owned clinic.
Nine states have some limits on facility fees charged to commercial health insurance, ranging from prohibiting them for telehealth visits to broader prohibitions on charges for preventive care or all outpatient care, according to the Center for Insurance Reform at Georgetown University.
Josh Dobson, CEO of the North Carolina Healthcare Association — a group that represents hospitals — told legislators that facility fees help pay for medical staff, equipment, and supplies in hospitals and hospital-owned clinics.
Just because independent practices don’t separately list facility fees doesn’t mean they’re not rolling them into the overall bill, Dobson said.
Regulating fees would make it more difficult for rural hospitals to stay open, he said.
“Restricting or eliminating facility fees would jeopardize patient access to vital services, reduce hospital capacity to respond to emergencies, and threaten the care of vulnerable populations,” Dobson said.
Sen. Jim Burgin (R-Harnett) questioned hospitals charging patients facility fees after buying established medical practices.
People pay those fees either through their insurance premiums or with tax dollars through government health insurance plans, he said.
Burgin recounted the case of a client of his whose bill for a medical visit increased $100 when a hospital purchased the medical practice where he is a patient.
“I think that’s what’s frustrating to a lot of people,” Burgin said. “Nothing changes but the ownership.”
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