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  • RogueDadMD
    replied


    Interestingly BCBS said the hospital can charge the fee “if they want to.”  The lab in the office building is not open 24 hours per day.  I guess I am talking about this because the charge for a venipuncture really is ridiculous to me.  I really have to think about where I send patients now because many would have a hard time with a fee like this.  I have paid it before I realized what it was for.  I have paid fees for a CT angiogram to R/O a PE after traveling done in the hospital (the same fee as the blood draw) but this seemed reasonable to me. I understand the hospital has to cover costs but they lose business if they overcharge on something so simple because once people understand the rules they go elsewhere.
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    You are 100% right -- it's the complete lack of transparency that helps maintain this.

    However just putting up a sign with the facility fee is also misleading, because how much you pay depends entirely on whether you have insurance and what type of insurance.  A patient with a fancy PPO plan may pay almost nothing while the one on the HDHP with a $10k deductible may pay all.  However even that fee may be contractually decreased by the contract w/the insurance company.  The person w/o insurance may get an automatic 50% off the price.

    Simply creating a menu of fees/prices is meaningless because the US has constructed a healthcare system where those numbers mean nothing to any given individual.  The hospitals take advantage of it.

    Quest may not charge a facility fee, but they can't possibly tell you what you are going to pay as an individual when you walk in the door for a blood draw.  The system isn't set up to do that and doesn't know how to do that in msot cases.

    The cost to the SYSTEM will be cheaper at Quest than at the hospital, but there's no guarantee the patient will see a substantially different cost.

    Leave a comment:


  • StarTrekDoc
    replied
    saying in business:  pigs get fat;  hogs get slaughtered.

    Outpatient Phlebotomy fee pain point :  clearly is below $250.    I would say anything beyond $25 will cause flight.

    Leave a comment:


  • Kamban
    replied


    I understand the hospital has to cover costs but they lose business if they overcharge on something so simple because once people understand the rules they go elsewhere.
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    By having such ridiculous charges for a venipuncture the hospital is killing the goose that lays the golden eggs.

    I occasionally attend the tumor board and the radiologists ****************************** and moan about the quality of MRI and mammograms done at an outside independent facility compared to theirs. To my eyes I find both to be equally good, just that the techniques used for MRI are different.

    What they fail to realize is that by having sky high charges many patients opt to use the independent facility for their mammograms and MRI. That facility has started doing their own biopsies and are sending to an independent path lab that charges less, hence the hospital loses out on the pathology portion too.

    The day is not too far when an independent surgical facility will perform the surgery and the surgeons will lose due to high charges.

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  • Hatton
    replied


    overhead to stay open 24 hours a day an
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    Don’t get me wrong. I’m not a fan of facility fees either. But I certainly understand why a business charges it….because it can!
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    Interestingly BCBS said the hospital can charge the fee "if they want to."  The lab in the office building is not open 24 hours per day.  I guess I am talking about this because the charge for a venipuncture really is ridiculous to me.  I really have to think about where I send patients now because many would have a hard time with a fee like this.  I have paid it before I realized what it was for.  I have paid fees for a CT angiogram to R/O a PE after traveling done in the hospital (the same fee as the blood draw) but this seemed reasonable to me. I understand the hospital has to cover costs but they lose business if they overcharge on something so simple because once people understand the rules they go elsewhere.

    Leave a comment:


  • The White Coat Investor
    replied
    Don't get me wrong. I'm not a fan of facility fees either. But I certainly understand why a business charges it....because it can!

    Leave a comment:


  • RogueDadMD
    replied


    Ya but isn’t that kind of the point? A blood draw doesn’t need an MRI or a hand surgeon (although I’m not a doctor so maybe there is some reasonable contingency I have no idea exists, feel free to correct me). At some level, why should he (the blood draw patient) subsidize the folks that do need all that other stuff?
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    The point WCI is making is that if you want to go get a blood draw at the lowest price, then you go to a place that only does blood draws and doesn't have to cover overhead to stay open 24 hours a day and offer a variety of rarely used services.

    It's no different than any other service -- if you want an oil change for your BMW at the lowest price, go to Jiffy Lube, not the BMW dealership that's also covering overhead for complex repairs, better technicians, the dealership lights and security system, and using it to pad their bottom line, etc.

     

    Leave a comment:


  • DoubleMDs
    replied
    We have battled with one of the hospitals where I work for two years about the "facility fee." They were charging most new patients an extra $100 just for showing up. It was easily one of the top patient complaints. Now they at least only charge it to "out of network" new patients, but it's still ridiculous. Surprised you had to become a patient to find out it existed.

    Leave a comment:


  • ko
    replied







    I just have a problem with being charged $250 for a $6 service.
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    You think having a hospital open is a $6 service? Have you looked around? It costs a lot of money just to keep the lights on, the doors open, and the rooms clean.

    It might be a $6 service done in a clinic or an outpatient lab where the overhead is much lower, but someone has to pay the overhead for a hospital. Is it more fair to have the inpatients pay for all that even though lots of outpatient stuff is being done in the hospital? Or should the outpatients pay some of it? If the outpatients, how do we decide how much they each pay? Should it be weighed according to what they’re there for? Or just make it a flat $250 a piece?

    At any rate, part of the salary of doctors employed by hospitals comes from bogus facility fees like this one, so be careful what you wish for.

    People complain about a $1500 bill for a small laceration in an ED. What they don’t realize is they are paying to have doctors, nurses, techs, lab tech, x-ray techs, standing around waiting for them to come in for their laceration. Plus all those overpriced bandaids and suture kits. Plus the MRI machine down the hall, just in case. And those hand surgeons that expect to be paid to take ER call? Someone has to pay for that too.

    I guess what I’m most surprised about is that you had no idea this was going on. This isn’t new. Not by a long shot.
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    Ya but isn't that kind of the point? A blood draw doesn't need an MRI or a hand surgeon (although I'm not a doctor so maybe there is some reasonable contingency I have no idea exists, feel free to correct me). At some level, why should he (the blood draw patient) subsidize the folks that do need all that other stuff? At some level, it seems reasonable that you can't aggregate every single expense that anyone needing healthcare might need, and then divide a fixed portion evenly. There are much cheaper and lower-overhead ways to do a blood draw, and a truly competitive market would never let a blood draw get charged a disproportionately high amount of overhead, no? A transparent market would drive specialized procedures to appropriately overhead-burdened facilities if the larger hospital isn't going to charge competitive rates.

    But again, I'm not a doctor, so take this all with a huge grain of salt, as you all understand this world much better than I do. I just have the typical frustration that many patients do dealing with the current system, as good as it may be.

    Leave a comment:


  • Hatton
    replied


    You think having a hospital open is a $6 service? Have you looked around? It costs a lot of money just to keep the lights on, the doors open, and the rooms clean. It might be a $6 service done in a clinic or an outpatient lab where the overhead is much lower, but someone has to pay the overhead for a hospital. Is it more fair to have the inpatients pay for all that even though lots of outpatient stuff is being done in the hospital? Or should the outpatients pay some of it? If the outpatients, how do we decide how much they each pay? Should it be weighed according to what they’re there for? Or just make it a flat $250 a piece?
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    I had personally never paid a facility fee.  I am pretty healthy.  As I stated the IM doc I saw is not a hospital employee but the blood draw station was in a hospital owned office building.  I did not see this charge coming.  I would be fine had there been a sign.  I think this is what makes patients crazy too.  The lack of ability to predict the cost of stuff without surprise fees.  I understand hospitals are overhead intensive operations. I also have concerns about where I send my patients.  If someone needs a simple blood test I don't want them charged $250 every time.

    Leave a comment:


  • StarTrekDoc
    replied
    In isolation that maybe true.  The facility fee is another junk 800 fee IMHO.

    We have markups to cover the cost of business and some border on gouging as an industry where the 'cash price' of a lab is 10% of the listed rate and where write downs of 60-80% is commonplace.

    That, however, doesn't explain a $250 fee for phlebotomy.  Central line draw with a home health RN visit perhaps, but outpatient facility venipuncture?

    We get little complaints now, but if we placed $250 facility fee on our signs, I'm sure there will be some serious negative Press Ganey remarks forthcoming.

     

    Leave a comment:


  • The White Coat Investor
    replied




    I just have a problem with being charged $250 for a $6 service.
    Click to expand...


    You think having a hospital open is a $6 service? Have you looked around? It costs a lot of money just to keep the lights on, the doors open, and the rooms clean.

    It might be a $6 service done in a clinic or an outpatient lab where the overhead is much lower, but someone has to pay the overhead for a hospital. Is it more fair to have the inpatients pay for all that even though lots of outpatient stuff is being done in the hospital? Or should the outpatients pay some of it? If the outpatients, how do we decide how much they each pay? Should it be weighed according to what they're there for? Or just make it a flat $250 a piece?

    At any rate, part of the salary of doctors employed by hospitals comes from bogus facility fees like this one, so be careful what you wish for.

    People complain about a $1500 bill for a small laceration in an ED. What they don't realize is they are paying to have doctors, nurses, techs, lab tech, x-ray techs, standing around waiting for them to come in for their laceration. Plus all those overpriced bandaids and suture kits. Plus the MRI machine down the hall, just in case. And those hand surgeons that expect to be paid to take ER call? Someone has to pay for that too.

    I guess what I'm most surprised about is that you had no idea this was going on. This isn't new. Not by a long shot.

    Leave a comment:


  • q-school
    replied
    That's funny, adventure. Ha ha.

    Leave a comment:


  • adventure
    replied




    I just have a problem with being charged $250 for a $6 service.
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    so, healthcare?

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  • Hatton
    replied
    I just have a problem with being charged $250 for a $6 service.

    Leave a comment:


  • The White Coat Investor
    replied




    I am really mad about something and I would like to get some input from this forum before I start firing off angry emails to the CEO of my hospital.  I recently went to see my internal medicine doc about some joint pain and increasing Raynaud’s Syndrome in my hands.  I am generally very healthy so I rarely have blood drawn.  He ordered some blood testing which was done in a lab draw station in a medical office building not in the hospital itself but on campus.  The only procedure performed was a venipuncture.  I received a bill from the hospital for $250.  I called my BCBS carrier and was told the hospital is charging a “facility fee”.  She stated they can do this if they want to.  I told her this was not a procedure or a complex test but a simple blood draw.  This charge does not go toward the deductible.  I have my office manager contact the hospital billing office but they subcontract the billing out.  We have contacted the billing company and formally disputed the charge.  I got a robo-collection call yesterday while seeing patients.  Am I crazy or is a $250 charge for a blood draw over the top! (BCBS paid the lab charges at their negotiated rate FWIW.)
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    Why do you think hospitals can pay so much when they purchase practices? It's all about the facility fee. The facility fee is why Free Standing Emergency Departments exist.

    Leave a comment:

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