Q: Are Carle facility fees generally covered by insurance? Also, does OSF HealthCare charge facility fees, too?
A: I checked with two health insurers with a lot of members in our area, Blue Cross Blue Shield and Health Alliance Medical Plans, and both said facility fees are subject to the deductibles their members must meet before their health plans begin paying.
And the short answer on OSF HealthCare is OSF doesn't charge facility fees in this market, according to LAURIE HURWITZ, the system's senior vice president of revenue cycle.
Facility fees are charged by some health systems that operate both hospitals and doctors' offices to help support the cost of their hospitals by using "provider-based" billing. That means physician offices and some other health services outside the hospital are designated hospital outpatient departments, and patients are charged both a professional fee by the provider and a facility fee by the hospital.
"Blue Cross and Blue Shield of Illinois suggests members speak with providers about billing separate facility fees when outpatient care is provided in a provider-based facility," said company spokeswoman COLLEEN MILLER. "We discourage our network providers from such billing practices as we understand that those fees can increase costs for our members."
Carle recently updated its list of hospital outpatient departments where facility fees are charged, and the list includes all Carle physician offices at the north and south clinics (except for oral and maxillofacial surgery) in central Urbana, Mahomet, Monticello, Rantoul and Danville on Vermilion; the south clinic lab and radiology; cardiology services in the Carle tower; maternal fetal medicine and maternal fetal sonography in the Carle center building; the Digestive Health Center; the Expanding Children's Hearing Opportunities (ECHO) program; Carle Spine Institute; Carle North Annex; Champaign facilities on Curtis Road, Kirby Avenue and Mattis Avenue; the Urbana clinic on Windsor Road, Convenient Care Plus, lab and radiology at Carle's Mattoon clinic on Hurst, orthopedic and sports medicine, and the plastic surgery center.
Carle's new clinic at Carle at the Fields will also be considered a hospital outpatient department when it opens next month.
There's not one flat facility fee at Carle, according to DAWN WALDEN, senior vice president and chief revenue cycle officer. Insured patients pay different facility fees based on what their health plans have negotiated with Carle, much as rates are negotiated for professional services, she said.
Hurwitz said OSF HealthCare does charge facility fees in some of its other service areas, though on a very limited basis. In those situations in which doctors' offices are considered hospital outpatient departments, billing for Medicare patients is split into facility and professional fees, and Medicare patients who don't have any secondary insurance may face two co-payments and two deductibles.