Facility fee on employee medical bills – Frequently Asked Questions
Employees who encounter a facility fee as part of their medical bill may have questions on what these charges are. These FAQs are designed to answer some common questions about facility fees.
What is a facility fee?
Some medical providers charge additional fees as part of clinical services they provide patients. Some may assess a facility fee when a patient receives care at a hospital or hospital-based outpatient facility. A facility fee is usually designed to help cover costs related to facilities maintenance, as well as other expenses such as personnel, equipment and supplies.
Are facility fees covered under Penn State health insurance plans?
Yes. Like other medical expenses, fees included in your medical bill are covered under Penn State’s health insurance plans, and are subject to deductible and/or coinsurance until your plan year maximums have been met. After your deductible has been met, costs for care, including facility fees, will be covered at 90%.
What triggers a facility fee?
A provider may charge a facility fee for services a patient receives in a physician’s office or outpatient clinic that is owned or controlled by a hospital or medical provider.
Are facility fees common?
Each medical provider bills for its services differently, so the use of fees will vary from provider to provider. Some providers may add a facility fee to some types of care delivered, while others may charge differently for their services.
How much are facility fees?
Each medical provider bills differently for its services, so a facility fee, if assessed, will differ depending on who the provider is. Patients can reach out to their providers for specific information about fees.
Are facility fees a new phenomenon?
No, the practice among some medical providers of charging facility fees is not new.
Can Penn State or Highmark tell the provider how to bill?
Employers and health plan administrators, such as the University and Highmark, do not control how or when health care providers charge facility fees, or how providers choose to list charges in their correspondence with patients.
What should I do if I have questions or issues about a facility fee that I’ve been charged?
For specific questions or concerns about billing, including questions about facility fees, we encourage you to speak directly with your physician, who should be able to help you clearly understand what you are being billed for.
Please know the employee benefits team in Penn State Human Resources is committed to supporting you and helping you navigate questions about your benefits. Please call HR Services at 814-865-1473, submit an inquiry through WorkLion or live chat us in WorkLion.
How can I avoid paying a facility fee?
While we cannot limit a provider from submitting valid claims, Penn State Human Resources is committed to helping you understand and navigate your benefits.
While decisions about who you see for your care are highly personal and entirely up to you, the University’s employee benefits team can help to connect you with Highmark if you would like to explore other care providers who may offer similar services, which could help you avoid facility fees. Please call HR Services at 814-865-1473, submit an inquiry through WorkLion or live chat us in WorkLion to get started.
How does Penn State advocate for employees when specific concerns arise?
As Penn State’s health plan administrator, Highmark oversees negotiations with all service providers. Penn State’s benefits team is regularly in touch with Highmark, and when provider concerns do arise, we share those concerns and work with Highmark to advocate for our employees and for Penn State. It remains Penn State’s goal to provide the highest quality health care at the lowest possible cost for our employees and their families.