Insurance not covering facility fees for regular doctor office visit
Been getting hit with additional bills for “outpatient” facility fees for regular doctor visits. I haven’t came across this issue before and wondering if anyone can provide me with some insight.
My primary care doctor practices under a large hospital system (Baylor Scott & White). I have recently enrolled in on a new health care plan and I’ve specifically chosen a plan that has low copays to avoid surprise medical costs. In the past, I have never had an issue with these types of plans as they are usually very straight forward when it comes to billing. I could go to a regular scheduled doctor visit, specialist, or urgent care visit and would only be billed the copay ($30-$45) after the visit.
However, I am now noticing that even regular preventative care visits, I get 2 bills for EACH visit that seemingly is charging for the same services but one is billed from the hospital (they call it their facility fee or an “outpatient” fee) even though it was not technically a “hospital visit” and I have another bill is from the physician of which I only need to pay the copay (this is the bill I am used to). I have never received an additional “facility fee/hospital” bill before, so I am confused on how this structure works. Unfortunately, my insurance won’t pay for this facility fee until I reach my deductible. This ends up costing me almost $200 for each routine doctor visit, which I feel is a bit outrageous, as I am used to only paying a small copay (approx. $30) each time. I feel that it is a bit unfair that I am paying a high premium for a “good” insurance plan, and I end up paying so much additional fees. I just want to know, is it commonplace/normal for insurance plans to be structured this way? Have I just been getting “lucky” in the past with better insurance plans that cover all these additional facility fees? Or is it actually unusual for the hospital/dr office to be charging all these fees for regular doctor visits and I should actually be looking at switching doctors instead?
Thanks in advance!
