Unfortunately, understanding the different charges on a medical bill isn’t always so black and white. For instance, inpatient fees differ from outpatient fees based on location and the types of services you receive. On a bill, you may also see separate charges for office visits and imaging (like X-rays or ultrasounds), as well as facility fees. And then, there’s the matter of health insurance and potential co-pays.
For some people, all of this confusion means they'll choose where to receive medical care based on cost—as was the case with one doctor and mother, whose failed attempt to sidestep hospital fees ended up trapping her in a $1,000 worth of extra costs.
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A primary care doctor herself, Danielle Ofri, MD, was strategically trying to avoid an expensive, overcrowded emergency room when she took her young daughter to an urgent care center for wrist and ankle X-rays. In a self-written essay for The New York Times, Ofri noted that non-hospital X-rays typically cost about $100 per image. Thus, when her eyes landed on the bill’s $1,168 radiology charge, her jaw and wallet hit the floor.
As it turns out, Ofri had visited a hospital-affiliated urgent care center. These are sometimes called hospital outpatient departments or HOPDs.
In other words, “they do some of the same outpatient care just as doctors’ offices and clinics do but because they are considered part of a hospital, they get to charge hospital-level prices for these outpatient procedures,” Ofri explained.
So, while she had taken her daughter to an urgent care location in a strip mall, the X-rays were being conducted via an actual hospital—with hospital-based pricing.
“When I inquired about the bill, I was told that the center was hospital-affiliated and as such, is allowed to charge hospital prices,” she wrote. “Since these facilities don’t necessarily look like hospitals, patients can be easily deceived and end up with hefty financial surprises.”
The realization hit Ofri like a ton of bricks. After all, if she, a doctor, was blindsided, how many others would fall for this secret billing trap?
“I’m a doctor who works in a hospital every day, and I was fooled,” she shared.
Ofri referenced a National Institute for Health Care Reform (NIHCR) study in which HOPDs charged an average of $758 more for a colonoscopy compared to procedures done at non-HOPD locations. Imaging such as ultrasounds and magnetic resonance imaging (MRIs), or in Ofri’s daughter’s case, X-rays, can cost hundreds more than at a doctor’s office.
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Patients also have to factor in facility fees, which are steadily on the rise and can cost thousands, according to Health Affairs. This particular billing trap is already being discussed on Reddit. In one thread, several users claimed they’ve been slammed with multiple bills in varying dollar amounts for the same exact visit.
“My specialist doctor's office is in a hospital and I literally have to pay my doc fee and hospital fee just because his office is in the hospital, even though I'm not checking into a hospital or having any sort of procedure, it's so annoying,” shared one person.
Another wrote, “I'm still sitting on a $500 bill because I went to see my gyno for a 10 minute follow up chat, no examination. I sat in the waiting room longer. But apparently there's now a separate facility fee so to even speak with my doctor in person, I get to pay a $500 bonus.”
They added that since learning about the facility fees, they’ve started looking for a new doctor.
Meanwhile, a surgery patient at Mount Sinai said they were stuck with “unexpected” facility and surgery fees. “They absolutely at no point told me there would be a facility fee beforehand,” they wrote.
