MARY LOUISE KELLY, HOST:
You can learn a lot about the cost of health care in the U.S. by examining a single medical bill, and for our September Bill Of The Month, we're taking a close look at facility charges, which should be familiar to anyone who's ever been in a hospital. Dr. Elisabeth Rosenthal is editor-in-chief of our partner Kaiser Health News. She's here in the studio. Welcome back.
ELISABETH ROSENTHAL: Thanks for having me.
KELLY: So just basic definition - what is a facility charge?
ROSENTHAL: This is the charge for rental of the room. It's a common line item on hospital bills, but it also occurs on surgery center bills and sometimes even on bills from a doctor's office.
KELLY: Kaiser Health reporter Cara Anthony is going to introduce us now to someone who had one of those surprises, and then we'll talk a little bit more after. Here she is.
CARA ANTHONY, BYLINE: Brianna Snitchler is 27. She says life was just starting to come together. She and her partner were setting up a new home.
BRIANNA SNITCHLER: Sit. Good.
ANTHONY: Her student loan balance was down, and Brianna finally had health insurance through work, so she decided to do something about a small cyst on her abdomen.
SNITCHLER: Whenever I would go swimming or, you know, try and wear a crop top or anything like that, people would always call it out and be alarmed by it. People would be like, whoa. You should get that checked out.
ANTHONY: Brianna wanted to get the cyst removed, but her doctor suggested that first, they check the growth for cancer. She had a needle-guided biopsy at a hospital in Detroit. She was awake the entire time. She never put on a hospital gown.
SNITCHLER: I'm wearing my street clothes. I didn't have to change or do anything at all.
ANTHONY: A nurse numbed up her stomach, and the doctor took a sample from the cyst. Brianna says the whole thing took about 20 minutes, and then she was sent home. The results came back benign. The whole thing was painless until the bill came. Brianna owed the hospital $3,300.
SNITCHLER: Oh, did I cry?
EMI AGUILAR: You were sobbing hysterically. Do you not recall?
ANTHONY: That's Brianna's partner Emi Aguilar. They were both in shock. The biggest charge listed on the bill was for operating room services - nearly $2,200 for that. It's known as a facility fee.
AGUILAR: She panicked, and I was like, we're absolutely not paying this. This is astronomical. We don't have any disposable income.
ANTHONY: It felt like taking 10 steps back financially.
SNITCHLER: I remember a few days prior to that, I'd, like, checked my credit score, and I'm like, yeah. I think it was, like, 50 points higher than it was the last time I saw, and I'm like, hell yeah. I'm finally doing great.
ANTHONY: After a nudge from Emi, Brianna started making calls, hoping to discover a mistake.
COMPUTER-GENERATED VOICE: Thank you for calling the billing office and customer service department of Henry Ford Health System.
ANTHONY: But there was no mistake. That big charge was for overhead costs of the hospital, staff salaries and radiology equipment. But Brianna says when she booked her appointment, no one told her that.
SNITCHLER: Why is the facility fee $2,000, and why don't they tell you that the facility fee is $2,000?
ANTHONY: After the biopsy, a representative from the billing department told Brianna that the hospital isn't legally required to tell patients about fees ahead of time, and it's the patient's responsibility to check. Brianna says the whole experience could have gone better if the hospital would have been more transparent about the cost.
SNITCHLER: I do know now to ask more questions. I found that out the hard way, I guess.
ANTHONY: Tangling with the health system left her with billing headaches and debt. For now, she's decided not to get the cyst removed. I'm Cara Anthony.
KELLY: And we're back again with Dr. Elisabeth Rosenthal, and you were shaking your head during this piece, so I want to ask you a question here. Brianna Snitchler said, why are facility fees so high? And she also asked why nobody told her before the procedure. Can you help us understand?
ROSENTHAL: So the first thing to know about facility fees is that they're a business construct of U.S. health care. They don't exist elsewhere. You're essentially paying to rent the space and the overhead, and think about it. When you get your car fixed, the costs of the repair include the cost of the garage and equipment. You're not paying an extra fee for that.
KELLY: So why don't they tell patients before they have these procedures?
ROSENTHAL: As you heard from the hospital representative - which makes my blood boil - legally, they don't have to. But one basic fact that everyone should know is that a hospital facility fee is going to be a lot more than a surgery center facility fee, which is going to be a lot more than a doctor's office facility fee, where there may be no facility fee at all.
KELLY: So you just mentioned some alternatives there. Did Brianna actually need to have her biopsy at a hospital?
ROSENTHAL: Likely not. This was a minor procedure. Remember, she only had local anesthesia and didn't even have to take her street clothes off.
KELLY: So given what you've told us, does the adage buyer beware actually apply here?
ROSENTHAL: Well, I love this case because it's a case where knowledge of the system and its tricks can actually make you a better shopper. So many doctors perform procedures at different locations - for example, at a surgery center one day of the week and a hospital another. So when the scheduler asks you, hey, do you want it Tuesday or Thursday?, you should know that's not just about the day of the week. It's about the facility fees that might be added on. So you should always ask, can I have this at a cheaper place? I want it in the office if it can be done in the office.
KELLY: That's Dr. Elisabeth Rosenthal of Kaiser Health News. Thank you for being with us.
ROSENTHAL: Thanks for having me.
KELLY: And if you have a medical bill that you want us to investigate, head over to NPR's Shots blog.
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