Patients visiting hospital-owned doctors’ offices are increasingly encountering unexpected “facility fees,” charges that can range from as little as $25 to several thousand dollars. These fees appear on medical bills even when patients receive routine care, such as annual physicals, strep tests, or telehealth visits.

Facility fees are intended to help hospitals cover overhead costs, including specialized equipment, administrative expenses, and overnight care. However, when hospitals acquire independent physician practices, patients are still billed the fees even in outpatient settings, despite the absence of hospital-level services.

How Facility Fees Affect Patients

According to U.S. PIRG, these fees are creating financial burdens and discouraging some patients from seeking routine medical care. “Patients are being charged for overhead costs that are unrelated to the care they received,” said Patricia Kelmar, senior director of health care campaigns at U.S. PIRG. “This is driving up costs and causing people to hesitate to get their regular checkups and treatments.”

Facility fees first appeared widely in 2023 and have grown as more hospitals purchased independent practices. Today, about 50% of community clinics are hospital-owned, making the fees unavoidable for many consumers. Even when patients have been visiting the same doctor for years, they may face charges if their clinic is taken over by a hospital.

Only a handful of states require hospitals to inform patients about these fees in advance. In many cases, patients only see notices on the day of their appointment, often after taking time off work or arranging childcare.

Real Patient Experiences

Beth Davis of Mentor, Ohio, was shocked when she received a $2,418 facility fee for a cortisone injection to treat carpal tunnel syndrome. Her total bill for the treatment was $2,667.45. “I wasn’t even observed. The doctor walked in and gave me a shot — there wasn’t even an assistant,” Davis explained.

Her insurance covered roughly $1,000, leaving her responsible for $1,618, which she is contesting. “We were never notified of this charge. I didn’t even know it existed,” she said.

Regulatory Gaps and Consumer Protection

Currently, 21 states offer some protection against facility fees. Nine states limit such fees for certain outpatient care, while 13 require providers to disclose them in advance. Despite these measures, consumer advocates argue that stronger nationwide rules are necessary.

Kelmar emphasizes the need for transparency and reporting: “We need hospitals to disclose the fees they are charging. People deserve to know upfront, not after the fact.”

The Broader Impact on Americans

Health care affordability is a major concern for U.S. consumers. A recent KFF poll found that two-thirds of Americans are worried about paying for medical care, with one-third expressing strong concern. Unexpected facility fees add to this financial strain, potentially discouraging patients from seeking necessary medical services.

Experts warn that these fees could have long-term consequences, including reduced preventive care and higher overall medical costs, highlighting the need for policy reforms to protect patients.