Facility fee on employee medical bills – Frequently Asked Questions

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.

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%.

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.

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.

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.

No, the practice among some medical providers of charging facility fees is not new.

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.

Facility fee claims are covered under Penn State medical plans, subject to your plan deductible and coinsurance, at an in-network provider. The allowed amount per the contract between the provider and Highmark is applied to deductible and coinsurance and you cannot be balance billed for the difference between the allowed amount and the provider's full charge.

For specific questions or concerns about billing, including questions about facility fees, we encourage you to speak directly with your physician, who may be in the best position to speak with administration of the health system.

Currently, the vast majority of concerns surround Geisinger billing practices. Please review more information regarding Geisinger Patient Billing Services, including the locations designated to charge facility fees.

For other providers charging facility fees, we recommend you speak with your physician and contact their Billing Department for further information.

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.