Medical bills catch patients by surprise

You may be billed twice for the same visit.

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Ken Clauser expected to get a bill from his doctor following a recent check-up. He didn't expect to get a second bill, from the hospital system that runs the building where his doctor has his office.

That bill, from Coordinated Health Hospital of Allentown, was $202, trumping the $135 charged by his physician.

Clauser said that when he called Coordinated Health to ask about the charge, he was told it was a fee for using the hospital facility.

He told me he didn't even know he'd been in a hospital. He hadn't. But you don't have to be in a hospital to be charged a hospital fee anymore. If the facility where you are treated is part of a hospital network, it may charge the fees under federal Medicare rules.


Getting these bills is making people sick nationwide. It has prompted lawsuits in other states and calls for legislation in Pennsylvania.

"It's just another move by many of these hospital systems to generate additional revenue with no justification whatsoever," said state Rep. Dan Frankel, a Pittsburgh-area Democrat. "It adds nothing whatsoever to the quality of care."

Frankel said he intends to introduce legislation banning the fees or requiring them to be disclosed so patients can decide whether to pay them or search for a health provider that doesn't charge them. He says patients also should be offered alternative locations to get treatment where facility fees are not charged.

In a memo to other legislators Frankel said a constituent had a $145, five-minute, skin tag removal in a doctor's office located in a hospital-owned building and was charged a $705 facility fee for "operating room service."

Clauser said Coordinated Health told him the fee covers all sorts of things, such as the scale he was weighed on, the blood pressure equipment he used, the room where the doctor saw him and the clerical staff.

Clauser said his wife, Alma, was charged $40 for having her toenails clipped, and an additional $70 in fees.

"Something is rotten in Denmark when the building fees are nearly double what the physicians get," Clauser, of South Whitehall Township, told me in a letter venting about the charges.

Dr. Emil Diiorio, CEO of Coordinated Health, told me patients are getting something for the fees. He said they cover the expense of the hospital system delivering outpatient services at hospital standards.

"The reason these fees are there is to provide the quality that you are receiving and the safety that you are receiving in these facilities," Diiorio told me. "These facilities that are off-site … they're held to the same high standards."

Not everyone believes the fees are appropriate. In May, a class-action lawsuit was filed against hospitals in St. Louis, alleging their fees weren't disclosed and weren't necessary

"Patients have no idea that by walking into one doctor's office instead of another's they will pay hundreds of dollars more for the same simple in-office procedure," attorney Robert Friedman said in a statement when his firm filed the St. Louis lawsuit.

The Clausers and another Coordinated Health patient, Barbara Fadale of Lower Macungie Township, told me they weren't aware they were entering facilities associated with a hospital and subject to facility fees.

"That's the issue," Fadale told me. "People don't know."

Complicating matters is the fact that Coordinated Health isn't a traditional hospital. It's what Diiorio described as an "integrated hospital network." Instead of a central location, its services are spread across 17 locations in the Lehigh Valley, Poconos, Hazleton and Phillipsburg, N.J. Some of those facilities have traditional hospital services such as operating rooms and inpatient beds, while others offer only outpatient services.

The building where the Clausers and Fadale were treated, on Cedar Crest Boulevard in South Whitehall, has a mix of services. Various physicians have offices in the building, which also houses a surgical center and Coordinated Health's Allentown Hospital.

So I can see why some people wouldn't think they were entering a hospital. The small print on a sign in the building lobby says "Coordinated Health is a provider-based hospital network," but not everyone reads those signs or understands what that means.

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