In June, when Arielle Harrison’s 9-year-old child needed to see a pediatrician from the Yale New Haven Health System, telemedicine seemed like a good option. Since her son is not yet eligible for the COVID-19 vaccine, they can contact the doctor via video to avoid venturing into a sterile medical facility.

A few days before the consultation, she received a notification from the hospital, informing her that she would receive two consultation bills. One is to serve doctors. The second is the hospital facility fee, although she and her son will be at their home in Cheshire, Connecticut, and have never set foot in any hospital annex.

Harrison, 40, who works in the non-profit communications department, posted unpopular fees on Twitter, including photos of Maggie Simpson on the TV show The Simpsons She has an expression of disgust on her face, and the title is “GROANS”.

The next morning, she called the billing office and was told that the facility fee was based on the location of the doctor. Since the doctor will be on the property of the hospital, the hospital will charge a facility fee of between $50 and $350, depending on her insurance coverage.

“This is just one of many examples of a very difficult-to-use system,” Harrison said, referring to the intricacies of American healthcare.

Hospital facility expenses Has been criticized for a long time From patients and consumer rights protectors. The hospital stated that these costs could add hundreds or even more than $1,000 to the patient’s bill, which is necessary to pay for the high cost of keeping the hospital open and preparing to provide care 24/7.

However, it is not just hospital visits that cause facility costs. In the past few years, hospitals have been buying frantically, snapping up doctors, and then often starting to charge fees.The patient who sees the same doctor and receives the same care as at the previous visit is Hung up now Extra cost-because of changes in ownership.

It is even more troublesome to charge facility fees for the video visits that patients log in from the living room.

“The charges seem crazy,” said Ted Doolittle, the director of the Connecticut Office of Healthcare Advocates, which helps consumers with health insurance issues. “It will be angry, and it should be.”

Health finance experts say that facility fees for video appointments are still rare, even though the use of telemedicine surges during the COVID pandemic. Medicare allows hospitals to assess a small fee for certain beneficiaries who receive telehealth care at home during ongoing national public health emergencies, and may also charge people in private medical plans.

However, Harrison was lucky. After seeing her tweet, Doolittle reached out to her and offered help from his office. In Connecticut, hospitals prohibit charging facility fees for telemedicine access.

As part of a broader law passed in May designed to help residents access telemedicine services during the pandemic, Connecticut implemented what may be the state’s only ban on charges for telemedicine facilities. The facility fee ban will end in late June 2023.

Pat McCabe, senior vice president of finance at Yale New Haven Health System, said he could not explain why Harrison was notified that she would be charged for facilities for telemedicine visits. He speculated that her son’s date might be incorrectly coded. He said that under the new law, the health system did not charge any telemedicine patients for facilities.

But such costs are reasonable, McCabe said.

He said: “It offsets the cost of the software we use to facilitate telemedicine access, but we still have to keep it running,” he pointed out that the provider of telemedicine visits in the hospital will generate heat, electricity and maintenance costs.

The American Hospital Association did not respond to a request for comment on the rationale for the cost of telemedicine facilities.

As the pandemic began to overwhelm the health system last year, hospitals have basically closed their doors to most non-COVID patients.

Kyle Zebley, vice president of public policy for the non-profit American Telemedicine Association, which promotes such care, said that telemedicine visits accounted for about 1% of pre-pandemic medical visits, which jumped to about 1% when it reached its peak last year. 50%. These appointments have been reduced and now account for approximately 15% of all types of insurance medical visits.

Before the pandemic, Medicare and Medicaid Service Centers severely restricted the telemedicine coverage for beneficiaries of Medicare’s fee-based services. However, as the elderly were more vulnerable during the pandemic, the agency temporarily relaxed its telemedicine rules. As long as the public health emergency continues, the agency will allow medical insurance beneficiaries in urban areas to access this medical service that was previously only covered in rural areas. Patients can get remote medical care at home instead of going to medical institutions to make video appointments as before. The agency has also strengthened the coverage of telemedicine services and expanded the types of providers allowed to provide these services.

Medicare allows hospital outpatient departments to pay approximately $27 for telemedicine visits for beneficiaries receiving care at home. Juliette Cubanski, deputy director of KFF’s medical insurance policy program, said that patients usually bear 20% of the amount, or about $5, but providers can waive patient cost sharing for telemedicine.

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Rick Gundlin, senior vice president of the Medical Financial Management Association, said that at the beginning of the pandemic, patients with commercial health plans are usually not charged for copays for telemedicine visits. The association is a member of medical finance professionals. organization. But recently, “the costs have come back,” he said.

According to Fair Health data, in the year ended June 30, the average cost of telemedicine access facilities in the business plan was $55. Before insurance discounts, it was a national independent non-profit organization that maintained a large Insurance claims database. According to Fair Health, in 2020, only 1.1% of commercial telemedicine claims include facility fees. This is lower than the 2.5% in 2019.

Experts predict that telemedicine will continue to be popular, but it is unclear how these visits and any accompanying facility costs will be handled in the future.

McCabe said he hopes the Yale New Haven Health System will recharge facility fees as permitted by state law.

“Providing these services has real costs in the health system,” he said.

Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.