Why you could see more ‘facility fees’ on your medical bills

LEE COUNTY, Fla. —

Pete Sonich carefully tracks what he owes for medical care. That’s why he was caught off guard by a couple of recent bills from Lee Health.

"I thought it was a scam or somebody made a mistake,” he said. "I paid my co-pay. This is something different that I'm totally unaware of."

The bills were for routine check-ups in 2025: one with a cardiologist and the other with a rheumatologist.

In past visits to these doctors, he owed a small co-pay, but that was it.

"These documents that you see are the first time — ever — as a patient, I've ever gotten charged for that," Sonich said.

What surprised him most was how they were labeled: hospital charges.

“Physically, I went to the office. I did not go to the hospital,” he said. “No blood tests, no X-Rays, nothing that would warrant a hospital visit."

Sonich called Lee Health and said the billing office told him the charges were "facility fees."

He’d never heard of those before.

"Is it for parking? Parking is free,” he said with a laugh. "I just want to know what I'm being charged for."

"It's extra money tacked onto a bill that is supposed to cover the amount it costs just for the facility to exist,” Caitlin Donovan explained.

Donovan is the senior director of the Patient Advocate Foundation, a nonprofit that helps people navigate medical costs, including facility fees.

She said they can cost thousands of dollars in some cases.

“In an emergency room (they) make sense. They have to have things like antivenom on hand that has a poor shelf life and a high cost of storage,” she said. “However, we're also starting to see facility fees pop up at your typical doctor's office who've maybe been acquired by a hospital system."

Those acquisitions are happening more often. Data from 2024 shows nearly four out of every five physicians are now employees of hospitals, health systems or corporate entities.

Additionally, nearly six out of every ten physician practices are now owned by hospitals or health systems.

“Your doctor's office that you've been going to for 20 years may be acquired by a health care system, and all of the sudden the next time you go in for an appointment, it may cost something dramatically different for the exact same service,” Donovan said. “Because now it's considered an outpatient facility."

In emergency departments in particular, facility fees have skyrocketed over the past two decades. Research shows that from 2004 to 2021, they’ve increased by more than 500% in the United States.

As of last year, 20 states have passed legislation that addresses facility fees, including Florida, which requires good-faith estimates to clearly identify any facility fees. State law also requires that hospital-owned outpatient emergency departments post signs in common areas stating that they charge facility fees.

Some states have cracked down even harder, banning providers from charging facility fees for physician office visits.

“I think it's a really good example of what propels the overwhelming cynicism the American public has toward our health care system at this point,” Donovan said.

Gulf Coast News asked for an interview with Lee Health, but a spokesperson sent a statement instead:

“Facility fees are billed separately from a physician’s professional charges and relates to the cost of the care environment where services are provided. Some Lee Health outpatient locations are designated as hospital-based departments, even when they are not physically located on a hospital campus. These sites operate under the same regulatory standards as a hospital and include additional clinical staff, equipment, technology, and safety resources. Because of this designation, services at these locations must be billed in the same way as hospital outpatient care. We strive to be transparent and to inform patients at the time of service when care is provided at a location where a facility fee applies.”

The Lee Health spokesperson said patients can find out which locations charge facility fees by visiting this website and in the FAQs, choosing “Which LPG locations are Hospital Outpatient Departments (HOD)?” to see a listing.

"I was upset. And I still am. I don't feel patients should be charged this,” Sonich said.

His insurance will cover most of the charges. He’s left owing a little more than $100. But he said the dollar amount is not the point.

“If it's affecting me, how many other people here in Lee County is it affecting? Where they have no clue that they're getting charged for a ‘facility fee?’” Sonich said.

Whether it’s a facility fee or any sort of issue with your medical bill, Donovan urges you to fight for yourself if something doesn’t seem right.

“About half of all medical bills have a mistake in them. We've seen mistakes that would have been $30,000 mistakes,” she said. “It is worth it (to fight), especially for a high bill. Because those phone calls could save you thousands of dollars."

Donovan offers the following advice if you are having problems with a medical bill:

Delay before you pay. Never pay a bill right away, or before you get an explanation of benefits. Finding out if there is an issue is the first step in fixing it. Some problems get resolved in the claims process.

Appeal or negotiate the bill. Both are possible options. You could also be eligible for financial assistance and not know it. Never put large bills on a credit card because the interest can add more costs. Most providers can work out a payment plan of some sort.

Be patient and seek help. Donovan said it can sometimes take between 20 and 30 phone calls to resolve a case. While it may be frustrating, it’s important that people have patience throughout the process. It’s also important to know there are resources out there that might help.

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