‘It’s the principle behind the thing’: Patient raises concerns over UW Health facility fee

By Grace Ulch

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    MADISON, Wisconsin (WKOW) — A UW Health patient is speaking out after receiving two bills for a routine procedure. One for the procedure itself and another for the “facility fee.”

Tom Guthrie has macular degeneration, a condition that affects central vision, meaning he can have trouble seeing something that’s directly in front of him. Guthrie says he’s been receiving treatment for the condition for years in Arizona.

“An injection every six weeks to two months, depending on what the results are,” Guthrie said.

When he was in Arizona, he paid $45 out of pocket, then he moved to Madison.

“I come back here, I’m charged $45 plus a facility fee of $275. I can’t justify the 275 when I’m on fixed income,” Guthrie said.

Guthrie says he’s tried speaking with billing and patient relations. He’s either gotten no answer or been told “take it or go somewhere else,” Guthrie said.

A spokesperson from UW Health said they would not offer comment, but they did send us a link to their website with an explanation for the facility fees.

A hospital-owned clinic, also known as a “provider-based clinic,” is considered an extension of the hospital. Therefore, the clinic must meet strict patient safety standards and follow regulatory requirements of the Centers for Medicare, Medicaid and The Joint Commission. Appointments at these locations are subject to something called a facility fee. Both governmental bodies and commercial insurers direct that facility fees are billed separately from the physician’s or provider’s professional fees.

Patients who receive care in a hospital-owned clinic can expect to receive two bills: One for the facility fee and one for the provider care.

When care is received at a non-hospital clinic, all charges can be combined into one bill, so there is no facility fee.

Signs are posted in all clinics that require a facility fee. You can also refer to the billing practices brochure that is given to all new patients or contact our billing office with questions.

The website goes on to say facility fees represent all the costs of operating a health care building other than the doctors’ professional fees.

They cover the costs of equipment, utilities, maintenance, supplies and medications administered during a clinic visit. They also pay for care by non-physician staff such as nurses, pharmacists, social workers, medical assistants, respiratory therapists and dieticians.

Because hospital-owned clinics are required to meet strict patient safety standards and more regulatory requirements than physician-owned practices, facility fees also help to offset the cost of meeting these mandated requirements. Finally, fees also reflect some of the cost of training of physicians, nurses, pharmacists and other health care professionals.

Guthrie says to him, it just feels like an excuse to charge customers more.

“They can’t get enough money out of a person, so they add this facility charge,” Guthrie said. “It’s the principle behind the thing.”

Not all UW Health clinics charge this fee, and their website says all clinics that do have signs.

Guthrie says he looked at other clinics that offer the treatment he needs but the next closest is in Milwaukee.

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