Surprise fees at the doctor’s office

WASHINGTON (SOA) — A growing number of patients are getting hit with surprise bills from their doctor’s offices for unexplained charges or things that used to be free. It’s all leading to a lot of frustration and calls for more transparency. Spotlight on America Correspondent Angie Moreschi investigates why patients are increasingly getting nickel and dimed.

Patient blindsided by medical bill

Cheree Vasquez loves to garden but hurt her neck and ended up going to a pain clinic in Huntsville, Alabama for help.

It was the doctor’s office. I paid my co-pay, which was $60. At no point did he say these would be extra charges,” Vasquez explained.

She got seven numbing injections at a total of two visits and thought that was it.

But this September, a year later, she was blindsided by two additional bills totaling $1900, on top of the two co-pays she made and $3760 her insurance paid.

The surprise charges came from the hospital that owns the doctor’s office, even though she never went to the hospital.

“One bill was $922, and the other one was $979,” Cheree said. “To be honest, I felt anger. They didn’t tell me that they were going to bill me separately. If I would’ve known this, I would’ve never gotten those injections.”

Fees for things that used to be FREE

Unexpected fees from doctors’ office visits are becoming more common, even for things that used to be free and included in the service, like:

• Using your patient portal
• Room disinfection fees
• The doctor answering emails
• Writing prescriptions
• Writing referrals

Spotlight talked with another patient in Virginia about a surprise charge on her bill. She didn’t want to be identified publicly but told us she got some slightly bad news at an office visit and cried. Then, she says she was stunned to see a $20 charge for a “brief emotional/behavioral assessment” on her bill.

How can you be honest about your feelings, if you’re afraid you’re going to be charged for it,” the patient said, after sending us a copy of her bill showing the charge.

Call for pricing transparency

Cynthia Fisher is the founder of PatientRightsAdvocate.org, a non-profit that fights for medical billing transparency, and says pricing has run amuck in healthcare.

We have a system that is dysfunctional and broken because the consumer is not informed,” Fisher told Spotlight.

She blames charges like these on a trend in the healthcare industry, moving away from private practice for physicians and toward corporate ownership. Eighty percent of doctors today are employed by corporate entities, according to a 2024 report by the Physicians Advocacy Institute.

“The doctors are being owned by the insurance companies primarily and the hospitals in private equity now. It is big business to maximize their profits at every single point of care,” Fisher said.

Impact on patients

Spotlight found concern over unexpected charges is impacting how and when patients seek care.

“It makes me not want to go, because I don’t know what’s in store for me,” Cheree said.

A recent Gallup survey showed nearly 40 percent of Americans delayed medical care because of cost concerns.

Spotlight contacted the American Medical Association to get insight on why doctors are charging these fees.

While the AMA did not respond to follow up calls for an interview, a spokesperson told us some services, like answering emails, “can be a significant time drain for doctors,” justifying the need for additional fees.

He also called the Medicare payment system “broken” and cited a decline in Medicare payments to physicians. Reimbursements have declined by nearly 30-percent over the past two decades.

Hospital response

Spotlight also called Huntsville Hospital, which owns the doctor’s office where Cheree went.

When asked why she would get a bill from the hospital for a visit at her doctor’s office, the accounting department told us it could be a “facility fee” or “equipment fee.”

We contacted the hospital’s public relations office to request an interview. They declined and did not answer specific questions about what specifically the charges were for, or whether accommodation is made for a patient if they are not informed about the fees; instead, sending Spotlight this statement:

The patient received a bill from her physician for professional services and a bill from our facility, which is a hospital department. This billing practice at Huntsville Hospital is the same for every patient in the Pain Center and is communicated with the patient up front before service. Unfortunately, as is common with many large insurance companies, it took over a year for her insurer to make payment to HH. The bill that she received in September 2024 reflected the payment made by her insurance company and the final balance owed after her insurance. From the perspective of our hospital system, at the very top of the list of improvement processes to drive down cost in the healthcare industry would be for insurers to promptly and fairly pay providers for the services that we deliver.

When Spotlight followed up to ask for an itemized accounting of the charges, with Cheree’s permission, the hospital did not respond.

Disputing a medical bill

Cheree is now challenging the bills and has sent a formal letter of appeal to the hospital.

“I decided to fight back,” she said. “I don’t want to pay for something that I don’t believe is right and is fair.”

Despite her efforts to dispute the charges, Cheree just received another bill, from a third party acting on behalf of the hospital, threatening to send her to collections—which is prohibited by the federal government.

According to the Centers for Medicare and Medicaid Services, it is a violation of federal rules for a patient to be threatened with collections when in the process of disputing a medical bill.

While you’re in the process of disputing a bill, CMS says your provider or facility can’t:

• Move your bill into collections, or threaten to do so
• Collect any existing late fees on unpaid bills until the dispute process ends
• Take action against you because you’re disputing your bill

If your bill is already in collections, your provider or facility must stop pursuing payment, until the dispute process is resolved.

If you get a medical bill that doesn’t look right or you don’t understand the charges, PatientRightsAdvocate.org recommends you always call your doctor’s office to question it. And if you have to fight back to challenge the charges, they have a ‘step by step’ process to help you.