A Maine legislative task force that examined so-called facility fees charged to patients at hospitals and other medical settings is calling for advanced warning about the fees and restrictions on when they can be collected.

The task force released a report to lawmakers this week detailing the billing practice and recommending law changes to protect consumers from hidden and unexpected charges that can add hundreds of dollars to routine medical bills. A bill based on the report could go before lawmakers this spring.

The panel was created in response to a 2022 Portland Press Herald investigation into medical billing.

Sean Dundon, of Portland, was one of many patients who shared stories of unexpected and often hidden charges. He was socked with a $510 facility fee at Northern Light Mercy Hospital on Christmas Day 2021 for emergency department treatment for a cut finger, which didn’t require stitches.

Dundon called the task force’s recommendations “great progress.” He said he would have bandaged his finger himself if he had known about the facility fee in advance.

“Having (the fee) posted and disclosed during intake is key as there are many times the patient may seek care later or elsewhere if they only had the choice before the bill arrived,” Dundon said on Thursday.

Patients’ stories about getting surprised by the fees – often hundreds of dollars tacked onto medical bills – were highlighted in the investigative report about medical overbilling and insurance denials.

After the story was published in August 2022, Senate President Troy Jackson, D-Allagash, introduced a bill to regulate facility fees, but it was amended to form a task force to study the complex nature of regulating medical costs before recommending reforms. The 10-member task force met three times in December before coming up with its recommendations.

Facility fees are imposed by health care providers to help pay the overhead costs of running large medical facilities like hospitals. They are sometimes added to bills without explanation. In some cases, insurance companies will not pay the fees or will pay only a small portion, leaving patients on the hook for the charges.

Under the task force’s recommendations  – which could become a bill to go before the Legislature this session – health systems would be prohibited from charging facility fees for outpatient medical facilities, telehealth providers and other medical services not conducted in a hospital or on a hospital campus.

Three of the committee members, including Jeff Austin, vice president of government affairs for the Maine Hospital Association, objected to the proposal to ban facility fees at certain medical facilities, arguing that “such a proposal would have a devastating financial impact on hospitals, including the potential closure of some facilities and the loss of patient access to health care services,” the task force’s report said.

The task force also recommends that signs be posted in common areas of hospitals informing patients of facility fees, that the fees be listed separately on bills sent to patients and that patients be informed of the fees prior to the medical service being provided.

It’s unknown exactly how many patients have had to pay hundreds of dollars in facility fees. But, according to the task force, “with more health care services being delivered in outpatient settings and more patients being responsible for a greater portion of costs, more patients are being directly impacted by facility fees.” The report noted that facility fees are being charged at urgent care centers, multiple times for the same visit, and at telehealth appointments.

Ann Woloson, executive director of Consumers for Affordable Health Care, said regulating facility fees would help reduce medical debt for Maine people.

“I think this is a really good first step in the right direction,” Woloson said.

Stephanie DuBois, spokeswoman for Anthem Blue Cross Blue Shield, said the insurer supports the task force’s recommendations, although the changes wouldn’t have a broad impact because state law already limits the charging of facility fees in outpatient services for many people with private insurance. And facility fees are not the only way costs can be hidden in medical bills, she said.

“We are noticing claims with buried and hidden fees that a patient has no idea about, and seeing egregious price markups with little to no transparency – such as a $146 ‘restocking’ fee for saline, which has an acquisition cost of 2 to 5 cents,” DuBois said.

Twelve states currently regulate facility fees, according to the National Academy of State Health Policy. The task force’s recommendations were inspired by model legislation devised by the academy.

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