Zurik: One consumer’s lesson, from shoulder pain to facility fee

NEW ORLEANS (WVUE) - Nancy DuBois would have been a good friend to have in class. She takes detailed notes.

She jots down when she's waiting for a bill, for instance, as well as when she's mailed the check. And if you talk to her, no need to record the conversation - she has a detailed account.

"I was having terrible shoulder pain in the beginning of last year," she recalls.

DuBois could write a few chapters on her experience at Tulane Institute of Sports Medicine, which is an easy walk from Tulane's football stadium in uptown New Orleans.

"I waited two and a half months for the visit," she tells us.

The long wait ended with a 30-minute doctor's visit and a quick diagnosis. "It ended up being a frozen shoulder," she says.

What's strange to her: a visit to one doctor's office produced two bills that cost her almost $300 out of pocket.

"I really didn't understand what it was for," she says.

DuBois received her first bill from the doctor - her cost, $150.

"What I didn't expect was, the next day, I received a bill from Tulane Medical Center," she says. "And that bill was for $1,434."

Her part of that bill - an additional $137. Tulane Medical Center, owned by HCA Healthcare, labeled it "your emergency copay amount".

DuBois says she laughed, thinking the representative may have been kidding.

"And she said, 'No, no,'" she recalls. "And that's when I said, 'How can y'all do that? How can you even call it an emergency room copay when I wasn't near an emergency? And what semblance is there in the wording of waiting two and a half months, pairing that up with "emergency"?' It just didn't make sense."

DuBois learned about a type of charge popping up more and more in healthcare. "Blue Cross told me that people that - if, once again, the hospital owns the clinic - they can charge you a facility charge," she says. "It's up to their discretion."

As more and more doctors work for large hospital groups, healthcare consumers need to be aware of an often hidden charge - one that often costs lot of extra money, out of pocket.

"They should come up front and tell you, when you call to make the doctor's appointment," DuBois insists. "They should disclose that. That's a big deal."

DuBois shows us the note she wrote from that conversation: she spoke with "Sarah" in March, and was told the $137 was a facility charge, or facility fee.

"You're in a lot of pain," she tells us. "Usually when you go to the doctor, especially an orthopedist, you know, you're not on your A-game. You're not feeling well. And I remembered reading and signing. And I don't remember specifically seeing a facility charge. But the girl told me, she said, 'Oh, hold on, let me go read the documents.' And she said, 'It does say you may incur a charge.' And that's what I object to, because they use these ambiguous words. It's either, 'You may incur,' 'You might have this charge... Possibly.'"

"I think Nancy's a victim of what we call multi-system trauma - she may have only had shoulder pain when she went in, but she had billfold, purse pain when she left," says Dr. Brobson Lutz, who served three New Orleans mayors as the city's health director and is now in private practice.

Lutz calls these facility fees unfair. "I don't see how this can continue," Lutz says. "It's building a house of cards that's bound to collapse. Where's all this money coming from? What are they doing for all this money? Just hiring more administrators to make more complex schemes, to fleece more people? What's happening here?"

One doctor emailed us and wrote, "Hospital-based diagnostic tests and procedures will be more expensive because they have a hidden facility fee attached."

"It shouldn't really be imposed on individual patients," says Robert Field, a healthcare policy expert. "It's designed to be paid by large insurance companies."

As we've tried cracking the code on healthcare costs, we've seen sick patients charged for the doctor, the procedure, an anesthesiologist - and that extra facility fee.

"It's as though you bought an airline ticket and they charge you a separate meeting for the pilot and for the plane and for the fuel and for the waiting area," Field tells us.And sometimes, those facility fees can dwarf other charges: $2,200 for a woman who had a colonoscopy, for instance, and $1,400 for a North Shore resident.

"What are we paying for?" DuBois wonders. "Their rent? I mean, I don't get it - a facility charge."

DuBois says she's learned a lesson.

"I just thought it wasn't fair," she says. "We pay a lot of money for our health insurance premiums. We all have high deductibles, and we pay it. But I never really thought that they could get away with this, charging a facility charge."

She wants healthcare providers to be upfront and transparent.

"To me, if they have set regulations - which it seems that they don't, but they should - if you have an office visit and you have this, this and this, like X-ray's or whatever, then you will incur this amount of money extra," DuBois says. "And so, it's your decision whether you want to go or not and pay it. But this was after the fact. And I felt like it was hidden, almost."

Now, she has a list of questions to ask before she waits two and a half months for another appointment: "Who are you affiliated with. Are you a one-stop shop or one piece of a bigger puzzle? And will I, should I expect to get bills with other entities that are affiliated with you?"

She hopes her story helps other Louisianans trying to crack the code on rising healthcare costs.

"It's frustrating, and the fact that we're stuck... what do we do?" she asks. "When people hear this, of course you're going to get aggravated. You feel like it's not fair. And as I said, we're all doing our share. Everybody has to get paid. We're paying for services. But I really don't think that's right, to make us pay a facility charge."

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