Port st. Lucie, Florida – When the Cleveland Clinic began to acquire hospitals and medical offices in this region lined with palm trees six years ago, many Floridians were excited. Non -profit Ohio, classified among the best hospitals in the worldhas undertaken to provide expert care and a silver infusion to the Côte du Trésor de la State, an area north of Boca Raton over 55 closed communities.
But in the years following the blue and green panels of the Cleveland Clinic, apart from the dozens of medical offices, the patients began to receive unexpected invoices: additional $ 95 for a consultation with a neurosurgeon. A supplement of $ 112 to see a family medicine doctor. And $ 174 more for a neurologist meeting which previously cost only a co-payment of $ 50.
Confined, the patients contacted the firms and insurers of their doctors and learned that the new costs were “costs of the establishment” – the accusations that hospitals have traditionally billed in hospital stays and emergency visits, but now invoice more and more routine meetings in their ambulatory clinics. The costs, which are often not entirely covered by insurance, are intended to support the level of care higher than doctors’ firms provide hospitals.
For blind patients, this can mean paying hospital costs – even if they never set foot in a hospital.
“My heart fell,” said Brandy Macaluso-Owens, 43, a social worker who lives in Port St. Lucie. She received installation costs of $ 174 after a visit in March with a Cleveland Clinic gastroenterologist. “I probably met the doctor maybe as little as 15 minutes.”
The Cleveland Clinic defended installation costs in an email, saying that they are an “appropriate practice” that align themselves “on government regulations and industry directives”.
“These costs help only maintain some of the costs of maintaining ambulatory installations so that we can continue to provide high quality care and compatiating to all patients,” the Cleveland Clinic said.
The Cleveland Clinic is far from being the only charge costs of the hospital, which represent billions of dollars a year for patients across the country. The fees have become omnipresent in recent years, as the main health systems have accumulated doctors’ offices, which makes patients more difficult for patients to find independent practices: more than half of all doctors on a national level are now used by hospitals or health systemsComing up compared to a quarter in 2012.
To find out more about installation costs, look at “Nightly News With Tom Llamas” from NBC at 6.30 pm He / 5.30 pm CT and “Top Story” on NBC News now at 7 p.m. he.
At the same time, the costs of the establishment have become more visible due to the increase in health insurance plans with high deductibility, which leave patients to pay a larger share of their medical invoices before the triggering of their insurance. increased by around 47% in a decade.
These factors affect many patients who are already leaning financially. In the United States, about half of adults say they could not pay a unexpected medical bill of $ 500 or should go into debt to pay itAccording to the KFF health policy group.
Installation fees can reach hundreds of dollars, and even small amounts can quickly add up.
Has your doctor’s office billed installation costs? Here’s what you need to know
“People get really high invoices for simple and routine care,” said Christine Monahan, assistant research professor at the Center on Health Reform Insurance at Georgetown University who studied the problem. “They don’t expect to pay high bills for this. And it is not realistic to expect people to afford it. ”
The opposition to the costs of the ambulatory installation is a rare area of agreement between patient defenders and insurance companies, which argue that hospitals unnecessarily inflate the cost of care. Although the efforts to restrict installation costs have attracted bipartite support to the levels of the state and the federal government, the hospital industry has rejected, arguing that the costs are necessary To help finance the basic services such as 24/7 emergency services, and insurers should cover them.
These national forces have all collided in southeast Florida, where 11 patients told NBC News that Cleveland Clinic had billed them unexpected installation costs in recent years. For some, the costs were only a discomfort, a sign of climbing the cost of health care. For others, bills were too important a financial burden to support. And some refuse to pay them.
Billie Paukune Boorman, a waitress, was recently invoiced installation costs of $ 174 for the meeting of her daughter, nose and throat of her 13-year-old daughter, as well as more than $ 200 other unforeseen accusations.
“I don’t have that kind of money posing,” she said.
The Cleveland Clinic refused a request for an interview with NBC News and refused to comment on individual cases, but said in its emails that patients are charged installation costs in doctors’ offices who are classified as hospital ambulatory services, which must comply with more strict quality and safety standards than unachosting medical practices. Installation fees reflect “significant additional costs at hospitals compliance with these standards,” added Cleveland Clinic.
The Cleveland Clinic told NBC News that it had sent more than 250,000 letters to its Florida patients informing them of fees before their appointments, and said that it publishes panels in its offices saying that they are hospital ambulatory services. Medicare patients receive an additional notice when registering. The letters sent by the Cleveland Clinic say that patients can see “a change in relation to how you have been billed in the past” but do not explicitly note that patients can be loaded more at their pocket. Many patients who spoke at NBC News did not remember having received the letters.
The health system did not answer questions about how it determines the price of installation costs, but said that the costs “vary according to the establishment and the type of medical services provided”.
Several patients said that they had noticed any difference in their care after the implementation of the costs.
Last year, Irene Rauch, 66, director of semi-annual human resources, was billed for installation costs of $ 95 for an appointment with a neurosurgeon she had said that she had seen for the same type of meeting three months earlier for only a co-payment of $ 15. The additional accusation was not something she had planned.
