This is the first of a three-part series looking into what a facility fee is, why hospitals charge them, and what’s being done at the state level to protect people against surprise bills from facility fees.
Last June, WPSU reported on public outcry surrounding the increased use of facility fees at Geisinger outpatient clinics in the State College area. Since then, more than 20 people have reached out to the newsroom with their experiences and many remaining questions.
The unexpected bill
Beth Philips uses a CPAP machine to help her breathe while sleeping. She started to have new sleeping problems a few months ago. So, she went to see an insomnia specialist at Geisinger Healthplex State College, also known as Geisinger Gray’s Woods.
“I paid the bill, my copay, and left," Philips said. "A couple days later, I got an email notification saying that I owed $205.”
Philips said she thought the charge was a mistake. She called Geisinger’s billing department and asked about the fee, since there was no name or explanation for the charge.
“They could not figure out why that was on my… why I was being charged that. ‘We don't know what that's about. You need to call, you know, your health insurance company,’" Philips said they told her. "So I called the health insurance company, and she's like, ‘Yeah, that's a facilities fee.’ I'm like, ‘What are you talking about, a facilities fee?’”
Allison Hoffman researches health care law and policy at the University of Pennsylvania in Philadelphia. She says there are two kinds of fees medical providers can charge.
“The first one is called a professional fee, and that's what the doctor charges for their time and seeing you," Hoffman said. "The facility fee is the charge from the hospital, for the facility, for the hospital or the surgical center for all the overhead costs for the space, for the people who work there, for the maintenance, all of those kinds of pieces that are apart from the people who are providing the care for you.”
Hoffman said those facility fees are common at hospitals, but outpatient clinics can also charge them if they’re affiliated with a hospital and meet certain state requirements. Some requirements include privacy barriers, larger hallway sizes and certain accreditations for staff.
Geisinger said they made significant investments in Scenery Park and the Healthplex at Gray’s Woods to improve access to specialty care – and to add technology normally only available in hospitals. The Pennsylvania Department of Health has designated them “outpatient clinics” of the Geisinger Lewistown hospital, and they can now charge facility fees.
How much are facility fees?
The cost of the fee doesn’t seem to be consistent. On average, the facility fees people have reported to WPSU have been between $200 and $350 dollars. The highest amount we heard was from Sze Wing Yu, a Bellefonte resident who recently got an allergy test at Geisinger Scenery Park.
“So my charge comes down to $1,711, and I don’t know what to do about it," Yu said. "To pay? Or do I call and ask them to lower it? And if so, like, is that just arbitrary for them to lower it or not? I don’t really know.”
Yu said that charge is after her insurance covered more than $10,000 in facility fees. She said she doesn’t understand why the amount is so high considering her appointment was for what she thought was a routine allergy test.
"How could it cost that much to do a test that took like 10 seconds?” Yu asked.
Yu said she called Geisinger to ask about the charge, and they told her the facility fee covers equipment costs and lab work processed at the hospital. The Geisinger employee in the billing department also told Yu that it’s the patient’s responsibility to ask about pricing before an appointment.
Yu said that’s too much responsibility to put on a patient’s shoulders.
“My preventive care is also at Geisinger," Yu said. "I’ve never been hit with these fees before. So before I make my next annual checkup, I’m wondering, ‘Should I look into this? Should I just not go get a check up?’”
Other people have also told WPSU they’re thinking about skipping medical appointments because of these unexpected bills.
In an emailed statement to WPSU, a Geisinger spokesperson said there are no facility fees for primary care, family medicine, pediatrics and behavioral health providers.
Geisinger did not confirm whether facility fees will be charged for every specialist appointment or how the fees are calculated, and said the cost varies depending on individual insurance plans.
Penn State says its health insurance covers facility fees, in the sense that they count toward employees’ deductibles. But employees still have to pay the charges out of pocket.
Where are facility fees charged?
Several people told WPSU they’re planning to switch doctors, but there might not be any escaping facility fees.
"I just heard from an elderly couple that both use sleep machines, CPAPs, and they said 'We got all these charges, and we just switched to Mount Nittany,'" Philips said. "And I'm like, 'Yeah, Mount Nittany's going to be doing it, too, so be careful.'"
Multiple people told us they were charged facility fees around $300 dollars from Mount Nittany pulmonologists.
Mount Nittany confirmed to WPSU they do charge facility fees outside of hospitals for certain specialty care appointments, including wound care, sleep medicine, pain management, orthotics and their radiology and laboratory services.
Starting in May, Mount Nittany is moving to a new system that will allow patients to see appointment estimates online through MyChart, including the facility fee, without having to request it.
Why now?
Health policy experts say hospital consolidations are happening more often and leading to more facility fees.
In 2024, Danville-based Geisinger was acquired by Risant Health, a nonprofit subsidiary of Kaiser Permanente. At the time, hospital officials said the acquisition would improve affordability and allow Geisinger to invest more in cutting-edge technology.
Patrick Keenan is the policy director for the Pennsylvania Health Access Network, a consumer advocacy organization. He said facility fees are a nationwide problem.
“Pennsylvania isn't alone," Keenan said. "I mean, this is something that we're seeing in states across the country."
Keenan said it’s difficult to track the use of facility fees in Pennsylvania. His organization is also trying to track the fees.
“We don't know where this problem is happening, how frequently it's happening, how much or how often it's happening," Keenan said. "We can't answer the basic questions about it because, I mean, it really is that process that's just very opaque and not easy to understand and not clearly communicated to patients.”
There are bills moving through the Pennsylvania House and Senate to force hospitals to have more transparent pricing. Some states have banned facility fees altogether.
In the next part of this series, we explain how and why other states are cracking down on the practice, and why hospitals say they need the extra revenue stream.
