8/21/2025
Why Hospital-Owned Doctors Can Cost More
- Extra Billing Codes – Hospital-owned clinics may bill both professional and facility fees.
- Higher Negotiated Rates – Hospitals often negotiate higher reimbursement rates with insurers.
- Reduced Price Transparency – It’s harder to know the true cost before you get the bill.
The Surprise Billing Problem
Even if you choose an in-network hospital-owned doctor:
- You could be billed separately by the hospital.
- You might unknowingly receive services from an out-of-network provider working within an in-network facility.
- Emergency room visits often involve multiple providers with separate billing.
How to Protect Yourself
- Ask Upfront – “Is there a facility fee for this visit?”
- Check Ownership – Is your doctor’s office part of a hospital or health system?
- Request an Estimate – Hospitals are now required to provide good-faith estimates for scheduled care.
- Know Your Network – PPO plans often have more flexibility and out-of-network benefits.
Why PPO Coverage Helps
With a national PPO, you’re more likely to:
- Access independent doctors who aren’t tied to facility fees.
- Have partial coverage for out-of-network providers.
- Avoid the worst financial surprises when traveling or seeing specialists.
Example
A patient visits a hospital-owned cardiology clinic for a follow-up. The doctor’s visit is $250, covered by insurance. A separate $400 facility fee arrives later, not fully covered—turning an affordable visit into a costly one.
Final Thought: Facility fees and surprise bills are often hidden costs of hospital-owned practices. Being informed—and choosing the right type of insurance—can protect you from unnecessary expenses.
Want to learn how the right plan can help you avoid surprise medical bills? Call (716) 503-1113 for a free coverage review.