Submitted by HombreDeCamote t3_117j41m in baltimore
Anyone been to see a dermatologist at John's Hopkins Outpatient facility on Caroline St.?
Apparently they charge an admission fee of some type as the practice is located in a hospital (I think that's the justification at least) and it seems like it is case by case as far as whether this fee will be covered by insurance.
Anyone have any experience with this and did your insurance cover it? If so, who is your insurer?
Thanks!
Thank you!
if you see any kind of provider located in a hospital your insurance company can charge you a facility fee, used to be $50. telemedicine ftw.
Depends. If your doc is physically located at a hospital location and providing telemedicine services you’ll still get hit with the facility fee. I’m not saying it’s fair it just is what it is…sigh
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Wait, so if you see a JH doctor at the hospital its $50 more than if you see a JH doctor at any of the satellite offices?
Depends on the insurance company…I learned the hard way a few years ago when I saw one of my doctors at Hopkins Bayview for a routine checkup. $100 facility fee. Same doc, same appointment at their “Community Physicians” satellite location, no facility fee.
No.
The facility fee is required to be a separate line item for outpatient hospital-based visits. So people notice it. You are still paying it for other outpatient visits but the charge items are together so you might not see it listed.
Edit: every hospital has this information on their website if you search for the facility fee.
I don't think that's true. My dermatologist is at Mercy downtown and they have signage all over their office that warns of the facility fees and suggests that you visit their other office in Lutherville or Overlea if you want to avoid fees.
My insurance now pays for the fee (Carefirst) but years ago when I had a plan through Evergreen it did not pay for it.
This is just where insurance muddles things and creates confusion.
It's explained on Mercy's website in the FAQ for facilities fees.
>A hospital facility fee is separate from and charged in addition to the fee billed by your doctor for the professional services provided during the visit. In a non-hospital setting, these fees are billed together.
So I have BCBS Illinois and in their general regulations they have this statement: https://i.imgur.com/6ftpHcP.png
I'm seeing a doc at JH next month so it will be interesting to see how that plays out. They are in network with BCBS Illinois so they should be bound to this provider contract stating no facility fees.
That will be interesting!
The facility fee as a separate line item is Maryland law.
Do you know why this law is in place?
Well, it's sort of a long story so I'll leave a lot out but if you want to know more, you can Google " HSCRC and Facility Fee"
Maryland is special when it comes to rates charged by hospitals. I believe it's the only state that has their own Cost Review Commission (HSCRC). The HSCRC is a state agency that basically sets cost ranges for healthcare services. They actually set the rates hospitals can charge for the facility fees.
Anyway, two of the goals of the HSCRC is price transparency and lowering costs (and they do a pretty good job). The bill basically says hospitals can charge the facility fee, but it needs to be transparent (they have to tell you about it) and the bill also says the patient can request a written estimate of charges at any time before or during their visit.
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Not JH but I had the same thing happen to me with Mercy, saw a dermatologist at their office on the hospital campus, got hit with a $50 facility fee my insurance didn't cover, started seeing her at another office not on the hospitals campus.
They had a sign posted at the office warning about a potential uncovered facility fee, I didn't know what it meant at the time.
Facility fee is a separate ‘benefit’ in your insurance in addition to the Specialist Visit benefit for seeing the doc. It is sometimes referred to as a ‘clinic visit’ for Hopkins. It could be an additional copay or coinsurance. Call the doctors office and ask them for the cpt codes for both the dr and the facility, then call your insurance company and ask how they cover it.
Thanks, insurance is hard to navigate sometimes and this was helpful.
$50 payment to the building, $50 payment to a specialist (my insurance waives the specialist bill if my primary does the referral, but it costs me $30 just to see him and I'd rather save my time than $20).
Oh and they charge like $15 for parking.
Good way of putting it, thanks!
I was just there and I don't recall what my insurance did or didn't cover but I got a $73 bill after the fact. Considering I had minor surgery I thought it was a bargain. I didn't really read the fine print, sorry.
BlueCross/BlueShield
No need to apologize this was really helpful, thank you!
Call your insurance company and see what they will cover. Facility fees vary greatly and so does coverage. I had a ten minute derm appt at the outpatient center and got hit with a $200 facility fee. My insurance at the time didn’t cover them. My current insurance does cover it so it varies from policy to policy.
Which policy or provider do you use now, if you don't mind sharing? Thanks for your reply.
Sickofbaltimore t1_j9bynbf wrote
It's called a Facility Fee and is standard practice in this situation. Pretty easy to look up now that you know the term.
A Facility Fee is applied when an outpatient visit occurs within a hospital and covers the use of the room, specialty staff and equipment.
Insurance is so variable that I won't comment on it.