Are facility fees raising your medical bill? Some patients get charged twice

USA Today – Sunday, February 1, 2026
By Ken Alltucker

During a routine visit to a medical office in suburban Boston, Suzanne Maguire had a small plug put in her tear duct to treat persistent dry eye. She paid $600 for the procedure, which took just a few minutes.

Weeks later, the Arlington, Massachusetts, woman was mailed a second bill for about $600. She thought it was a billing error and called the doctor’s office. But an employee explained it wasn’t a mistake. The second bill included a facility fee charged by Boston-based Mass Eye and Ear, an affiliated hospital Maguire never set foot in.

Maguire, who works as a financial planner, scrutinizes medical bills because she has a health insurance plan with a $3,000 deductible, the amount she must pay before coverage kicks in. The hospital bill for a suburban doctor visit flummoxed her.

“It was shocking,” said Maguire. “I was 15 miles away from the hospital.”

In a statement, Mass Eye and Ear said the suburban medical office is a hospital-licensed facility and is transparent about billing practices.

Hospital-owned doctors charge extra fees

Hospitals are increasingly buying independent doctors’ offices and clinics and levying hospital fees for such non-emergency visits. In 2024, about 55% of doctors worked for a hospital or health system, more than double the rate in 2012.

People who visit these hospital-owned clinics might get two bills – one from the doctor and a second from the hospital, even if they’ve never received care within the hospital. In other cases, consumers get a single bill itemized with charges from the health care provider and the hospital.

The hospital fees for doctor or clinic care can range from $50 to more than $1,000 and often are assessed without warning patients, according to the Outpatient Outrage 2026 report released Jan. 29 by U.S. Public Interest Research Group, or PIRG.

PIRG officials said the report highlights a growing trend of hospitals charging fees for routine care. People often visit doctors office or clinic to prevent health issues from worsening. Such “outpatient” care − delivered at a doctor’s office or clinic − is usually less costly than hospital care.

“The whole point of preventive care is to save costs overall and make sure people are going for regular checkups,” said Patricia Kelmar, PIRG’s senior director of health care campaigns. “Yet now we’re getting billed as if we’ve been lying in the hospital bed.”

The American Hospital Association said facility fees provide resources hospitals need for round-the-clock emergency and trauma care at hospital emergency rooms. Beyond inpatient care, the AHA said hospital-owned outpatient clinics often take care of sicker patients and face stricter regulations.

“Facility fees are an important way that hospitals may bill for costs to maintain all the essential services and capacity they provide to their patients and communities, especially as Medicare and Medicaid continue to underpay hospitals and commercial health insurers increasingly delay or deny coverage for care,” said Molly Smith, American Hospital Association’s group vice president for policy.

But consumers are struggling to pay the unexpected charges.

West Covina, California, resident Todd Bash, 60, was billed more than $14,000 in facility fees for an injection he received at a hospital-owned pain clinic in Los Angeles. A health insurer reimbursed the hospital more than $1,800, and Bash paid more than $450.

Frustrated, Bash asked his insurer to provide a list of area pain clinics that were part of the insurer’s network. He called the providers on the list, but most were hospital owned or didn’t take his insurance. He eventually found an independent clinic that cost him just $37 for a pain injection.

The PIRG report said a New Mexico woman paid more in facility fees than she did to health care practitioners during multiple 2025 visits to a hospital-owned primary care clinic and a specialist. A nurse practitioner billed $73 and a hospital charged a $92 fee for the same visit.

The hospitals are adding fees at outpatient clinics and offices they own for medical services such as routine checkups, mammograms, colonoscopies and telehealth appointments, PIRG said.

Massachusetts resident Maguire paid $180 for each of several telehealth appointments in 2024 with a nurse practitioner who prescribed an anxiety medication. Beginning in 2025, the mental health hospital that employed the nurse practitioner added on facility fees that more than doubled the charges.

When Maguire first complained about the extra charges, the nurse practitioner wasn’t aware the hospital fees were being assessed. So Maguire switched to a non-hospital telehealth prescriber and now pays $120 per appointment.

Hospital care two to four times more expensive

Research suggests hospitals that buy outpatient clinics and surgery centers often drive up costs for people seeking non-emergency care.

Older Americans on Medicare pay two to four times more for services at a hospital-owned outpatient department compared with an independently-owned physician office, a study funded by Arnold Ventures reported.

Several states are scrutinizing hospital fees for outpatient care and consumer advocates urge better protections and disclosure for patients. A total of 22 states have passed laws or regulations to address facility fees, said Christine Monahan, assistant research professor at Georgetown Center on Health Insurance Reforms.

State laws often aim to help consumers through better disclosures or other protections.

“They are going to help consumers not get these surprise, out-of-pocket bills,” Monahan said.

Monahan said consumers often don’t have the extra cash to afford the extra fees. Consumers with insurance often must pay deductibles or coinsurance, which requires people pay a percentage of their medical bill.

“Every dollar really counts,” Monahan said. “These charges showing up in more and more locations is a real problem for consumers in their day-to-day lives.”

Monahan also said hospital facility fees also drive U.S. health spending higher for government health programs such as Medicare, Medicaid and private insurance companies. Insurance companies then raise monthly premiums for employers who sponsor health insurance plans for workers and individuals who purchased Affordable Care Act coverage.

Americans who buy their own ACA insurance coverage are paying sharply higher costs because enhanced tax credits expired at the end of 2025. KFF, a health policy nonprofit, estimated average costs for 22 million Americans who get subsidized ACA insurance more than doubled in January.

A KFF tracking poll released Jan. 29 reported health care affordability is Americans’ top economic worry in 2026. About 1 in 3 poll respondents said they are “very worried” about their ability to afford health care. Health care topped other common affordability concerns, including paying for groceries, rent or mortgage, utility bills or gasoline and transportation costs, according to the the KFF poll.

PIRG: More protections needed for consumers

PIRG officials said states and consumers can take steps to protect from unexpected medical charges.

Before getting care at a doctor’s office or clinic, consumers should ask office staff whether they will be charged facility fees.

Insurers might balk at paying hospital fees for an outpatient visit. That leaves the consumer with extra costs they must pay out of pocket, Kelmar said.

The PIRG report also recommended states enact stricter reforms to limit fees and protect consumers.

Although 22 states have enacted some reforms, none have eliminated extra fees hospitals charge at outpatient locations. PIRG recommends states adopt a “same service, same price” standard to prohibit price differences.

PIRG also recommends states:

• Protect patients by prohibiting facility fee charges for routine outpatient care.
• Require all health providers to have a unique billing identifier. That would allow consumers and insurers to clearly see which provider is billing them, rather than allowing a single billing identifier for all locations a hospital or other entity might own .
• Require public reporting of all facility charges and payments.

Access this article at its original source.