Health care expenses must end surprise medical bills - a patient must only pay for treatment not facility fees

Published in the Portland Press Herald and Consumers for Affordable Health Care, in Augusta Maine:

WATERVILLE, Me- Kelly Brignac, photographed at her home in Waterville on Tuesday, was charged a $1,500 facility fee at Maine General after getting an ultrasound in the emergency department because of pregnancy complications that later led to a miscarriage. 

Kelly Brignac obstetrician’s office was closed on a Friday afternoon in early May when she started bleeding from complications early in her pregnancy.

Feeling like she had no other option, the 34-year-old from Waterville went to MaineGeneral Medical Center in Augusta’s emergency department. Hospital staff gave her an ultrasound and a blood test, and sent her home with instructions to follow up with her doctor.

She miscarried at home that evening.

When she received the hospital bill, Brignac said she was shocked to see a charge for more than $2,000. She would have to pay out-of-pocket because she hadn’t yet met her deductible.

When she looked closer, Brignac said she saw a $1,544 charge that wasn’t linked to a specific procedure or test. The hospital later confirmed it that the charge was a so-called facility fee, Brignac said, who also showed a copy of her bill to the Portland Press Herald.

Hospitals add such fees to help pay for their general operating costs, but insurance plans often don’t cover them and patients are often surprised by them.

“I did feel like I was being taken advantage of,” said Brignac, a Colby College professor. “I had no idea I would be charged this much. I got a $2,000 bill that essentially was all for the doctors telling me, ‘Well, you have to wait and see.’ ”

Brignac said she is not criticizing the care she received at the hospital, only that the bill was so high compared to the limited services she received in the emergency department. The ultrasound, blood test and other miscellaneous charges cost about $600, and she didn’t contest those charges.

Brignac said she reluctantly paid the bill.

Hidden charges, denies claims: Medical bills leave patients confused, frustrated, helpless

A Portland Press Herald investigation revealed that Brignac’s experience is common for patients who seek care in Maine's hospitals (and in other states as well), which sometimes hide facility fees in medical bills with no explanation.

Even worse, the insurance companies sometimes refuse to cover these fees, leaving patients on the hook for hundreds of dollars in unexpected charges simply because they went to a hospital instead of seeking treatment from another provider.

McKenna said the facility fee “covers the additional costs of providing care in the hospital or hospital outpatient department and is separate from medical staff care provided to the patient.”

A FOCUS OF SCRUTINY:  Facility fees have been the focus of scrutiny and debate in the Maine Legislature since 2022, when the Press Herald highlighted patients’ complaints about the fees in an article about the nation’s byzantine system of medical billing.

Maine Senate President Troy Jackson, D-Allagash, proposed strong limits on the fees, arguing that there should be limits on the fees and that hospitals need to be more transparent so patients aren’t surprised by the extra charges.

Hospital officials, however, have long argued that facility fees are an important part of the revenue stream.

Jeff Austin, vice president of government affairs for the Maine Hospital Association, argued during the legislative debate this year that banning facility fees would “have a devastating financial impact on hospitals, including the potential closure of some facilities and the loss of patient access to health care services.”

Joy McKenna, spokeswoman for Maine General Medical Center, said she would not comment on a specific case to protect patient privacy. But, she said, a facility fee is a standard charge for all patients cared for at the hospital.

“Hospitals are generally bound by the federal Anti-Kickback Statute and the Civil Monetary Penalties Law, which prohibit waiving or reducing fees, including facility fees, for individual patients as a routine practice,” McKenna said.

After years of debate, studies and intense lobbying by the hospitals, Maine earlier this year passed a watered-down version of facility fee regulations that only requires hospitals to state that they charge such fees, without requiring that the amount of the fees be disclosed. Even the slimmed-down version of the law hadn’t yet gone into effect when Brignac went to Maine General in May.

Stricter regulations, such as barring the fees from being charged during telehealth appointments or at outpatient facilities, were discarded.

Fifteen states, including Maine, have some laws regulating facility fees, while the majority of states either have no laws on the books or do not implement bans or restrictions on the fees, according to an analysis this year by the PIRG Education Fund (Public Interest Research Groups).

Only seven states impose significant restrictions or bans, with Connecticut passing the strongest measures. Connecticut bans facility fees from being charged for outpatient services or telehealth appointments, among other regulations.

The PIRG analysis said there is “no rhyme or reason” for the amount charged in facility fees. “Facility fees vary tremendously, adding as little as a few dollars or more than $1000 to the bill,” the report said.

Ann Woloson, executive director of Consumers for Affordable Health Care, a Maine-based patient advocacy group, said she would like to see the Maine Legislature take more steps to have stronger regulations of facility fees. Brignac’s case is an example of why more needs to be done, Woloson said.

“There needs to be more transparency on how facility fees are developed by the hospitals,” Woloson said. “And the fees should be appropriate for the service provided.”