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.”

Immigrant children in cages - evil Donald Trump humanitarian crises

Shut down detention centers for migrant children!

In the United States of America, in the year 2019, we have a detention center for children made up of tents. It’s on the edge of a swamp in the path of hurricanes. This for-profit child detention center houses 2,200 traumatized children who were separated from their families for the sin of fleeing violence. Its numbers are projected to quickly grow by 50 percent.

On April 8, the national law was broken when three Florida congresswomen were denied entry into the for-profit Homestead Temporary Shelter for Unaccompanied Children. 

What are they hiding?

As leaders of a local grass-roots organization, Central Mainers For Change, we decided it is time to shed light on this humanitarian crisis. We urge calls to our elected officials in Washington. Ask them where they stand on this issue?

Then, demand that they go to the detention center so they can see for themselves what is happening there. Hopefully, they won’t remain so silent.

Also, demand that our representatives support the legislation brought forth by Sen. Jeff Merkley, D-Ore., and Rep. Judy Chu, D-Calif. The “Shut Down Child Prison Camps Act” – S.397 (Senate); H.R. 1069 (House) – demands that our government shut down unregulated child prison camps for immigrant children, like the one in Homestead, Florida.

We are Americans. As Americans, we know we are better than taking children from their families and putting them in cages and tents.

Mary Dunn and Stryker Adams

Central Mainers For Change
Waterville, Maine

Speaking about free speech on a college campus

At the University of Southern Maine in Portland, my alumni university, where I achieved my bachelors degree in nursing, the recently installed President Dr. Glenn Cummings reported to his staff about a free speech experience recently hosted on the campus. In his weekly "Missive" an informal message he posts to the University staff, Dr. Cummings, a former Maine legislator and Speaker of the House in Augusta, wrote this report, describing the participation in a planned program (following the Missive, is a letter to the editor, about the program, by Katherine Besteman):

Dr. Glenn Cummings

Dear USM community,

I look forward to seeing everyone as I return from my trip to Beijing, Dalian and Shanghai, for the purposes of recruiting for The International Academy at USM and for meeting with our sister university Dongbei, in Dalian. We discussed more international exchanges as well as proper USM faculty governance of our Chinese curriculum. Never having visited the Far East, I found the experience powerful - particularly the infrastructural and economic achievements of a rapidly growing society. A clear sense of collective mission and national pride exists at seemingly every level of society. More unsettling is the tight restrictions on access to information as well as personal expression. Heavily prescribed economic and social dictums from the communist central government raise questions about how a society best creates the 'most good for the most people' - the utilitarian ideal.

Speaking of free speech, allow me to extend my admiration to the many students and community members who peacefully assembled in Hannaford Hall and appropriately challenged or supported the conclusions of visiting speaker Rep. Lawrence Lockman on the Thursday evening, before vacation.

Rep. Lockman described, in his lecture, a legislative bill he has introduced this session in the state house calling for tighter immigration policies and restricting resources to new arrivals and asylum seekers. His position contradicts the basic ideals of our university that emphasizes inclusion and diversity as essential to a full education, wrote Dr. Cummings.

During the question and answer period, the students, and community members challenged his conclusions, his logic, and the ethics of his assumptions - displaying what an engaged and educated student body and citizenry looks like.

With the exception of some protesters inappropriately disrupting a simultaneous event in Woodbury designed to encourage thoughtful dialogue, I was proud of the conduct and approach of our university community. Starting with the Student Senate's thoughtful and productive position the previous week, the USM student population made itself a national model for resisting hate and discrimination while adhering to non-violence, and respect for civil discussion. Many universities failed at this; our students and community friends succeeded.

Rep. Lawrence Lockman of Amherst Maine; his district relies on 2000 immigrant and migrant workers to support a successful blueberry harvest!

In advance of the event, many in our USM community expressed their understanding to me of the need in a democratic society - and a university - to uphold freedom of speech and expression, even if many of us strongly disagreed with the content of the expression. Others, however, argued that any individual who proposes policies out of alignment with many in our university community (especially someone who has indulged in seemingly nasty and hateful comments in the past) ought to be censored from speaking at a university altogether. Their position tempts many of us. After all, why must we listen to someone like that? (Hmmm, MaineWriter observes how Rep, Lockman has spoken offensively about minority groups as reported in the media, although he subsequently issued public apologies.)

Several things come to mind. First, no one HAS to listen to such a position. Ignoring an event like this makes a statement as well, even if protesting peacefully in person may make a stronger one.

Second, Rep. Lockman's policies may be abhorrent to many of us, but he IS relevant. His party controls one body of the legislature, the governorship and all of Congress. His views align tightly with the man now in charge of the White House. Whether we like it or not, his positions are very real. What better way to place his position under the microscope of intellectual scrutiny than bringing him to a university? And scrutinize is exactly what our student body did. They engaged in thoughtful but tough questions and challenged his basic assumptions at every point.

Third, the door of free speech swings both ways. What we take away from one can be taken from the other. Should a request come from a different USM student group to bring speakers from the opposite perspective, it will undoubtedly draw criticism and cancellation demands from some sectors. But be assured, we will stand our ground in allowing speakers of all stripes to speak free at USM.

I hope this is helpful. For those who would like to discuss this event with me personally, I have set up a couple times for me to be available for that purpose. They will be on Thursday, March 2nd at 5:00 PM and on Friday, March 10th at 4:00 PM. Both sessions will take place in the President's Office. Please feel free to stop by.

Thank you all for making us proud of USM. 

A letter to the editor by Katherine Besteman followed up this program: WATERVILLE — I attended state Rep. Lawrence Lockman’s University of Southern Maine talk on “Alien Invasion” last week, not because I agree with his position, but because I don’t. I have spent a decade studying the impact of immigration and refugee resettlement in Maine. I’ve written on the importance of refugee resettlement programs, the benefits to Maine of welcoming immigrants, the positive economic impact of refugees on Maine and the forms of solidarity and support that immigrant communities build. I believe Maine should welcome immigrants and refugees, but Lockman views immigrants as a threat and a financial burden. His recent and forthcoming legislation punishes Portland for failing to require police officers to ask the citizenship status of those with whom they come in contact and holds Catholic Charities accountable for any crimes committed by refugees they have resettled. He supports the recent executive orders to halt immigration from seven Muslim-majority countries and all refugee resettlement. The legislator seems terrified of immigrants, and I wanted to try to understand why.

Here’s what I learned.

Most of Lockman’s speech recounted various acts by immigrants that harmed or might have harmed Americans: the two Iraqi men in Bowling Green, Kentucky, found guilty of attempting to provide weapons to al-Qaida in Iraq; the two immigrant men who passed through Maine before leaving the country to join the Islamic State; the three men who may have been immigrants who beat Freddy Akoa to death in Portland; the 9/11 hijackers.

Listening to the enumeration of these tragic but unconnected events, I struggled to follow the logic. Should the U.S. bar immigrants because some might become radicalized after immigrating? Should all immigration be halted because some immigrants commit crimes? Is Lockman suggesting that immigrants have a tendency toward radicalization or criminality?

I agree, that it’s important for government to provide safety and security for residents. But I cannot understand Lockman’s insistence that U.S. citizens should fear immigrants because some may be dangerous. More Americans are killed by white extremists than by foreign-born terrorists. More Americans are killed by animal attacks or heat waves than by foreign-born terrorists. Americans are more likely to be killed in a shark attack, by a lightning strike or by falling furniture than by a foreign-born terrorist.

Immigrants do not commit crimes at higher rates than non-immigrants; in fact, all available evidence indicates immigrants commit fewer crimes and have lower rates of incarceration than non-immigrants. Lewiston offers a close-to-home example: Since Somali and other immigrants began moving there in 2001, crime rates have fallen. Immigrants, it seems, actually make cities safer, not more dangerous.

The other concern offered by Lockman was his view that taxes should not be used to support immigrants, illegal aliens or refugees. But residents who lack legal status cannot receive public assistance; resettled refugees receive support only for 90 days after resettling in the United States (after which they are expected to be self-sufficient), and the offer of public assistance to other legal immigrants is based on the presumption that because they have earned the right of admittance to the U.S., they are entitled to the same benefits as other citizens when they fall on hard times. The real issue is whether or not we wish to welcome newcomers into our society and offer them the same civil rights our ancestors fought hard to achieve.

I believe that the 2,000 migrants who work the blueberry harvest in Lockman’s home region every year should have access to the same public services – medical care, workplace safety, legal protections – available to their citizen co-workers. I believe the immigrants who overwhelmingly staff American restaurants, provide elder and child care, harvest and process food, clean homes and offices and much more, deserve exactly the same access to public services as their citizen neighbors, including assistance when they are injured, lose a job or experience a family emergency.

Denying immigrants access to public services when they are between jobs or have a crisis is not only inhumane, but also self-destructively short-sighted. Short-term investments in immigrants pay long-term dividends. Look at Lewiston’s Somali residents – who, within a decade of their arrival, are sending their children to medical, law and nursing schools, speaking before the United Nations, running successful businesses, winning state and national competitions and revitalizing farmland in central Maine.

In short, immigrants make American cities better, not worse, and Lockman’s fear-mongering cannot alter that simple, long-standing truth. Take a trip to Lewiston and see for yourself.

In fact, MaineWriter drives to Lewiston at least once to three times a week.  I totally agree with the assessment by Katherine Besteman.