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What Colorado law protects with healthcare billing

Hospital
Posted at 11:10 AM, Sep 14, 2022
and last updated 2022-09-14 13:10:53-04

COLORADO — Derek Wilson's wife wasn't feeling well at the end of last year, so she went to urgent care. He says she was told the cost would be slightly higher because she went after hours.

Wilson said she was looked at for about five minutes and given a pain killer and a Benadryl. Months later they say they received bills from the facility, showing they owed more than $1,000 for the visit.

"My first reaction was, this can't be right, you gotta call them, let them know," Wilson said.

Part of the bill the Wilsons received included a "facility fee" for about $800.

"I'm not a billing and coding expert but I was like this can't be right," Wilson said "she didn't go in and have surgery, she wasn't put under, she received a pill that you would get from a Walgreens."

These so-called "facility fees" are becoming a growing problem in Colorado, according to the Colorado Consumer Health Initiative.

"It does feel like sort of the new sort of frontier as far as surprise bills are these facility fees," Adam Fox with the Colorado Consumer Health Initiative said.

Fox said typically facility fees have been used for hospitals, and usually for a patient staying for a procedure. Fox said it's not typical for an urgent care facility to charge a fee like this.

"What we're seeing is sort of a proliferation of these facility fees being tacked on to services they didn't used to be applied to," Fox said.

In 2019, Colorado lawmakers passed a law to prevent suprise out of network medical bills. This is where a patient unknowingly sees a provider they did not know was outside of their insurance network.

Wilson's case does not fit in with the 2019 law because the provider was in network.

"At the end of the day we need to make sure that consumers are not caught off guard by facility fees like this," Fox said.

Legislation has passed at both the state and federal level in recent years to try and increase transparency of costs and prevent surprise bills.

2019: Colorado Out of Network Legislation

2020: Federal "No Surprises Act"

2021: Federal Hospital Price Transparency Act goes into effect

2022: Colorado Hospital Transparency Law

In Colorado, an all payer claims database online tracks the cost of various procedures and facilities in the state. To explore the database click the following link: Colorado All Payer Claims Database.

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