Surprise emergency room bill sheds light on hospital billing debate

Kelly Brignac’s obstetrics office was closed on a Friday afternoon in early May when a patient began bleeding from complications early in her pregnancy.

Feeling like she had no other choice, the 34-year-old from Waterville went to MaineGeneral Medical Center’s emergency room in Augusta. Hospital staff performed an ultrasound and blood work on her, then sent her home with instructions to see a doctor.

She miscarried at home that evening.

When she received the hospital bill, Brignac said she was shocked to see a charge of more than $2,000. She would have to pay out of pocket because she hadn’t yet met her deductible.

When she looked closer, Brignac said she saw a $1,544 charge that was not related to a specific procedure or test. The hospital later confirmed the charge was a so-called facility fee, said Brignac, who also showed a copy of her receipt to the Press Herald.

Hospitals add such fees to cover general operating costs, but insurance often does not cover them and patients are often surprised by them.

“I felt like I was being taken advantage of,” said Brignac, a professor at Colby College. “I had no idea I was going to get paid that much. I ended up with a $2,000 bill that was basically all for the doctors telling me, ‘Well, you’ll have to wait and see.’”

Brignac said she was not criticizing the care she received at the hospital, only that the bill was so high compared to the limited services she received at the emergency room. The ultrasound, blood work and other miscellaneous fees totaled about $600, and she did not dispute the charges.

Brignac said she reluctantly paid the bill.

A Press Herald investigation found that Brignac’s experience is common among patients who seek care at state hospitals, which sometimes hide charges for services in medical bills without explanation. And insurance companies sometimes refuse to cover them, leaving patients with unexpected costs of hundreds of dollars simply because they went to the hospital instead of seeking treatment from another provider.

Joy McKenna, a spokeswoman for MaineGeneral Medical Center, said she would not comment on a specific case to protect patient privacy. But she said the facility fee is standard for all patients treated at the hospital.

“Hospitals are generally bound by the federal Anti-Kickback Statute and the Civil Monetary Penalties Statute, which prohibit the routine waiver or reduction of charges, including facility charges, for individual patients,” McKenna said.

McKenna said the facility fee “covers the additional costs of care provided in a hospital or outpatient department and is separate from the care provided to the patient by medical personnel.”

OBJECT OF CONTROL

Facility fees have been the subject of scrutiny and debate in the Maine Legislature since 2022, when the Press Herald highlighted patient complaints about fees in a story about the state’s complicated medical billing system.

Maine Senate President Troy Jackson, an Allagash Democrat, has proposed strict caps on fees, arguing they should exist and that hospitals need to be more transparent so patients aren’t surprised by additional charges.

But hospital officials have long said facility fees are a significant part of their revenue stream.

Jeff Austin, vice president of government affairs for the Maine Hospital Association, argued during this year’s legislative debate that banning facility fees “would have devastating financial consequences for hospitals, including the potential closure of some facilities and loss of patient access to health care services.”

After years of debate, research and intense lobbying by hospitals, Maine earlier this year passed a more relaxed version of its facility fee law that requires hospitals to merely state that they charge such fees, without having to disclose the amount. Even the relaxed version of the law had not yet taken effect when Brignac went to MaineGeneral in May.

More stringent rules were rejected, such as a ban on charging for telemedicine or outpatient visits.

Fifteen states, including Maine, have laws regulating facility fees, while most states either have no laws or no bans or restrictions on fees, according to an analysis this year by PIRG Education Fund.

Only seven states impose significant restrictions or bans, with Connecticut enacting the strictest measures. Connecticut prohibits charging for outpatient services or telemedicine visits, among other regulations.

PIRG’s ​​analysis found there was “no sense” in the amount charged in facility fees. “Facility fees vary widely, adding as little as a few dollars to more than $1,000,” the report said.

Ann Woloson, executive director of Consumers for Affordable Health Care, a Maine patient advocacy group, said she would like to see the Maine Legislature take more steps to enact stronger regulation of facility fees. The Brignac case is an example of why more needs to be done, Woloson said.

“There needs to be more transparency in how hospitals charge for services,” Woloson said. “And the charges should be proportionate to the services provided.”

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