In the first and second part of WPSU's series on facility fees, we explained what a facility fee is and the arguments for and against them.
The fees that started in hospitals are now charged at several medical offices in the State College area. These fees often aren’t communicated ahead of time and can cost hundreds of dollars.
In this last story of a three-part series, WPSU explains what state legislators are doing about facility fees and what you can do about them in the meantime.
Pa. lawmakers consider hospital pricing transparency bills
Some states have banned facility fees, or made hospitals inform patients about how much the fee will cost before an appointment.
Lawmakers in Pennsylvania say they don’t have enough information about how the fees are used in order to decide how, or if, to regulate them.
Dawn Keefer is a Republican state senator whose district includes Cumberland and York counties. She’s the prime sponsor of a Senate bill to improve hospital pricing transparency, which was introduced last spring. State Sen. Judy Ward, who represents Blair, Fulton, Huntingdon, Juniata and Mifflin counties, is one of the co-sponsors.
“I have bipartisan support, so it's Democrats and Republicans that are on the bill," Keefer said. "So it's my hope that we can drive this out, get this moving, that we can start this conversation because this is only step one.”
Keefer introduced that bill in the spring. There’s a similar bill in the House.
Keefer said the legislation would require hospitals to post the costs of their services on their websites. Many hospitals already do that to some extent, but Keefer said they would have to make that information easy to find and understand. And they would have to include facility fee costs. If they didn’t, they couldn’t collect on medical bills.
Keefer said her bill gives power to consumers.
“You could compare those prices, and not only that, maybe it's ‘I'm going to WellSpan no matter what,’ but I could say, ‘Wait a minute, what is this facility fee,’ right? ‘I can't afford that.’ Like, ‘Why is that on here?’ They could actually negotiate,” Keefer said.
Keefer said she introduced the bill after hearing from several constituents who were charged with facility fees. One man got a quote for $1,800 for a series of tests.
“And he said, ‘I know that that's just an estimate. It can go up or down around 10%.’ And then he got a bill after the fact for $3,800. He said, ‘You know, I'm not a mathematician, Dawn, but that's not a 10% difference, right?’" Keefer said.
Response from hospital systems
Keefer said she’s gotten pushback from hospital officials who want language about facility fees removed from the bill. Hospitals argue they need that extra revenue stream to recoup losses from low Medicare and Medicaid reimbursement rates.
Keefer said lawmakers could help reduce other pressures on hospitals if they have a full understanding of their financial situation, including income from facility fees.
“I'm trying to be sensitive to our providers as well, our hospitals, not trying to bank them as the bad guys, right?” Keefer said.
In response to a question from WPSU about this bill, a spokesperson for the Hospital and Healthsystem Association of Pennsylvania declined an interview and instead emailed a written statement.
In that statement, the spokesperson said Pennsylvania hospitals are committed to transparency. But, the spokesperson says they’re concerned about how the legislation would interact with the already existing federal “No Surprises Act.”
The "No Surprises Act" and what it means, or doesn't mean, for facility fees
Health consumer advocates showed support for the state bills at a recent webinar with the Pennsylvania Health Access Network. Erin Gabriel, the advocacy group’s government affairs representative, said state legislation is needed to improve enforcement of federal law.
“It would put some teeth behind the federal regulations. The first Trump administration put these regulations into place, basically saying, ‘Hospitals, you need to do this.’ But then they didn’t enforce it," Gabriel said. "Biden doubled down on that and said, ‘Yes, you need to do this,’ but again, there wasn’t really an enforcement mechanism.”
Last month, Trump signed an executive order reinforcing the requirements, saying hospitals have to provide the actual cost of services, not just an estimate, or else they could get fined.
The “No Surprises Act” technically includes facility fees, but it just means hospitals have to give an estimate if patients ask for one.
Plus, Gabriel said many Pennsylvania hospitals haven’t fully complied with the “No Surprises Act” for years. She said more lawmakers need to know about the issue.
“You can call your legislators," Gabriel said. "Call and leave them a voicemail saying, ‘Hey, I’d really like you to support Senate Bill 752. We really need facility fee and price transparency in Pennsylvania.’ Talk to your neighbors and encourage them to do the same thing.”
Gabriel was one of several speakers in that webinar, which also focused on how to appeal medical charges, including facility fees, both to your provider and insurance company.
How to appeal a facility fee, and whether it's worth it to do so
“Any charge that you’re charged, it’s always worth it to call the billing office and try and get it removed," said Patricia Kelmar, the senior director of health care campaigns with the U.S. Public Interest Research Group.
Kelmar said filing an appeal can be a long and complicated process, and there’s a deadline to do so after getting a bill. But, she said you don’t have to go through the appeals process alone.
“If you have a doctor you’re working with and they’re just as frustrated as you that you’re not getting coverage and your insurance isn’t paying for the care that you needed, you can authorize them to fill out the appeal letters and help you fight your appeal," Kelmar said.
Kelmar said it can be helpful to get your doctor involved since they can also write a medical letter supporting your claim.
If you’re unsuccessful in submitting an internal appeal to your insurance company, you can submit a complaint to the Pennsylvania Insurance Department on their website.
But, the state’s insurance department encourages people to ask for an estimate beforehand.
Are facility fee appeals successful?
Even though Kelmar said it’s worth it to appeal a facility fee, she said she hasn’t heard of anyone who was successful in doing so.
“Because right now it’s legal. It’s legal for them to do this, which is why we really need to get going in Pennsylvania to start counting all of those facility fees, and then get our legislators realizing it’s time to ban them, to prohibit facility fees in outpatient settings," Kelmar said.
Meira Minard, a Houserville resident, appealed a facility fee from a telehealth appointment a few years ago with a provider based in Geisinger’s Danville hospital. Geisinger agreed to remove the charge then.
Geisinger recently charged Minard another facility fee at Gray’s Woods for $120 dollars. She appealed it twice and got rejected both times.
Minard hopes more people will speak out.
“People need to keep talking about it, because there's power in that," Minard said.
Minard is now appealing her facility fee with the Pennsylvania Insurance Department.
Sze Wing Yu, who got charged $1,711 in facility fees at Geisinger Scenery Park, reached out to WPSU after our first story. Yu said she negotiated with Geisinger to lower the fee to $1,283, but she also submitted a complaint to the state Attorney General's office. Because Geisinger offered a discount and Yu signed a fiscal responsibility form, her case was dropped.
"I guess I understand if a rural hospital system has a hard time financially... But it's the lack of upfront transparency, seemingly arbitrary pricing, and placement of all the blame on the patient that gets me," Yu said in an email to WPSU.
If you've tried to appeal a facility fee or have a story about facility fees to share with WPSU, email radionews@psu.edu or call 814-863-9171.
Listen to part one of the Facility Fees series about what they are and where around State College is charging the fees. And part two of the series about the arguments for and against the fees.
