By: Carolyn McLaughlin-Smith
Transparency in the health insurance business is a continual challenge. At Creative Benefits, we research policies meticulously before signing on the dotted line. But even when we dig deep and anticipate every fee — and pass that information along to policyholders — there are still fees we only learn about after claims are filed.
One hidden fee we’ve seen cropping up on bills lately is called a facilities fee. A facilities fee is an unanticipated and undisclosed charge tacked on to a bill for a minor diagnostic test or lab service.
Here’s how facility fees work. Say a policyholder needs a blood test. Their policy says blood draws are covered at 100%. The policyholder goes to their lab, checks in with the receptionist, sees the phlebotomist for a blood draw, then leaves assuming the service is fully covered.
A few weeks later, the policyholder receives a bill with a charge for a facility fee for the blood draw. It’s a small charge, but the policyholder is surprised because they believed the service was 100% covered.
The insurance company’s explanation for this discrepancy is that the blood draw itself was covered, but use of the facility was not. There is absolutely no way for a member to be aware of the fee nor understand how the fee is calculated or when it will be applied. This practice appears to be cavalier on the part of the facility as well as the insurer. But the policyholder had no way of knowing about the facility fee in advance. That’s not transparent. Or fair.
Since facility fees are usually small — sometimes only a few dollars — people may not question the charges. It can be easier to pay up than to waste valuable hours on the phone trying to get answers. Who has time for that?
At Creative Benefits, we believe a policy that says it covers a service 100% should cover it 100%. When we learn a policyholder with a plan fully covering a service is hit with a hidden fee — even a small hidden fee — we go to bat for them with the insurer.
Our customer service representatives are dedicated to helping policyholders resolve issues like facility fees. Because we want policyholders to get the optimal value from their benefits, we offer this service at no additional cost to group members.
Creative Benefits will always push for transparency. We urge all members who receive bills for inappropriate fees to contact customer service for help.
For other questions about health insurance or for help planning benefit programs that offer the best value, please contact Creative Benefits at (610) 325-0200
About the author: Carolyn McLaughlin-Smith is a Senior Benefit Consultant who has been with the firm for 11 years. Carolyn founded the Creative Benefits office in northeast Pennsylvania.