Mark and Victoria Hubert of Hobe Sound like to plan ahead, and their health care is no exception.
“My family has a history of some neurological issues, and it takes a long time if you need a doctor to get established as a new patient. So, I just went preemptively,” explained Mark.
Mark’s insurance company referred him to a neurologist near his home. It was the same doctor that his wife went to last year.
“I had been to this doctor twice, so we were both floored by this,” said Victoria.
Floored because after what Mark describes as just a routine, new patient exam at the doctor’s office, his explanation of benefits (EOB) shows he was charged an extra $174 for so-called "miscellaneous charges."
“I figured there had to be some mistake,” said Victoria.
“She asked me, 'What did you do? What happened?'" said Mark. “I reiterated the standard. I went and saw the doctor, paid the co-pay, and came out. There was no testing, there was no leaving his office. There was no lab work, there was no other interaction with anyone else."
Victoria did some digging and discovered the "miscellaneous charge" is actually a facility fee, a charge that’s typically reserved for hospital services. Victora was dumbfounded.
“I said, this doesn't make any sense. It was a regular doctor's appointment,” she said.
Mark’s neurologist is affiliated with the Cleveland Clinic, and his office is located inside a Cleveland Clinic building, which means patients are now subject to what the office calls "provider-based billing."
“This is not—it's just not right,” said Victoria.
But it’s not illegal and it’s becoming increasingly common, said Dr. Jay Wolfson, a professor and senior associate vice president at the University of South Florida’s College of Public Health.
“It's kind of like an overhead fee that the hospital is able to glom on,” explained Wolfson.
“It makes sense. I’m relying on this larger healthcare institution to help me manage my practice, or manage all my practices, and they may be paying all the salaries for my nurses and my medical assistants and my backroom people, and they've got all the software and the hardware that manages the building and the finance systems,” he said.
Wolfson also explained that these extra charges at the doctor’s office are nothing new.
“It's been used in Medicare for many years,” he said.
But it is expanding as more hospital groups acquire independent doctors' offices. It’s estimated that about 75% of US doctors are now employed by corporations, according to the Physicians Advocacy Institute.
In a statement provided by a spokesperson for the Cleveland Clinic, “provider-based billing is a Medicare classification,” which means hospitals have met certain regulations. As a result, its doctors’ offices are classified as “outpatient departments.” In other words, patients are now subject to an extra hospital professional and facility fee, even if they’ve never set foot in the hospital.
How insurance companies cover these extra charges varies depending on a patient’s insurance coverage.
“We’ve never seen something like this before,” said Mark and Victoria. They are now looking for new doctors outside of the Cleveland Clinic.
They’re also appealing the facility fee and the additional $17 doctor charge that was tacked on to their new provider-based bill. It’s a bill, the Huberts believe, that puts the provider over the patient.
“It wasn't a devastating amount of cost. It was just unexpected, unclear, and we were just surprised by it,” said Mark.
“You know, I gave him probably the biggest hug I could ever recall giving him, and he held on tight"
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