Did your doctor’s office charge you a ‘facility fee’? Here’s what to know.

In Minnesota, a family received an unexpected charge of more than $ 400 after taking their daughter to the doctor for stomach pain. In Ohio, a man was billed $ 645 more for an ear, nose and throat specialist. In New Hampshire, a resident was billed additional $ 1,000 for an appointment with an urologist.

Towards in the country, patients express frustration concerning “installation costs” – loads that a wide range of hospital systems adds to appointments in the establishments they own, including doctors offering routine care.

Hospitals can charge installation costs even when a patient has not set foot in a hospital. More than a dozen patients who expected their insurance to cover most of the cost of their appointments in the offices of ambulatory doctors told NBC News that they had been blind by fees, which are billed in addition to the cost of vision of medical providers and can easily run hundreds of dollars.

To find out more about this story, look at “Nightly News With Tom Llamas” from NBC at 6.30 pm He / 5.30 pm CT and “Top Story” on NBC News now at 7 p.m. he.

The accusations have become more widespread in recent years, as more and more doctors have been employed by hospitals and, as insurance plans leave patients by paying more for care before their coverage is doing. In some communities, there is so much consolidation of health care that it is difficult to find practices that do not charge easy costs.

Researchers say that patchworks laws to regulate costs have not been held.

“In most states and situations, there are not really limits at their height,” said Christine Monahan, assistant research professor at the Center on Health Insurance Reforms at the University of Georgetown, who studied installation costs.

Hospitals argue that the costs of the establishment are necessary to finance the higher level of care they say that they provide in the offices of ambulatory doctors, as well as to help maintain 24/7 services such as emergency rooms. The American Hospital Association says that the costs of the establishment should be covered by insurance companies, while insurers claim that the costs unnecessarily swell the cost of care without improving its quality.

Here is what consumer defenders and health policy experts say patients should know about the costs of the establishment.

Before your appointment: what to ask

Experts recommend that you ask each time you make an appointment if there are installation costs – even for the doctors you’ve already seen. The ownership of a doctor’s office, an affiliation to the hospital or policies may have changed since your last visit.

If you are told that there will be installation costs, ask for a good faith estimate of the expected charge, said Patricia Kelmar, principal director of health care campaigns to the US public Research Group, a consumer defense organization.

And do not assume that your insurance will cover the invoice.

Last year, Melissa Finnegan, by St. Paul, Minnesota, was billed installation costs of $ 423.15 for an appointment with a pediatric gastroenterologist for her 3-year-old child. When she tried to fight it, she did not discover the health system or her insurance company willing to move.

“I postponed paying it for as long as possible,” she said.

When you get the invoice: how to give meaning to the charges

If you receive an unexpected medical invoice after an appointment, call the billing office to request a detailed invoice to understand the costs. The costs of the ambulatory installation can be listed under other names, such as “clinical” costs. In office signs and other disclosure on installation costs, hospitals can designate practice as “providers based on providers”, which means that patient invoices can be divided into two separate costs: one for doctor and one to visit the establishment.

“People see the bill and assume, because it is on their invoice, that they will have to pay it,” said Eric Waskowicz, senior director of state policies in the United States, a non-partisan organization that fights for affordable health care.

But in some cases, you may not have to pay. Insurers suggest that patients are waiting for them to receive their explanation of the advantages so that they can review the part of their plans will cover and that they do not accidentally count.

You must also check the laws of your condition to make sure that you have been properly charged: some states prohibit the costs of facilities for remotely visits, for example, while others prohibit installation costs for preventive services or in certain types of medical offices.

“Know what is the law, then use it if you can protect yourself from these costs,” said Kelmar.

The American Hospital Association advises patients to familiarize themselves with the coverage of their insurance schemes and says that if they have received unexpected installation costs to confirm that their insurance has “treated appropriately” their complaints.

What if you can’t afford to pay

If you cannot afford to pay installation costs, try to call the office of the medical supplier to see if the costs can be withdrawn. If that doesn’t work, tell your insurance company, Kelmar said. Insurance may be able to work with the billing office to reduce your current responsibility.

There are other options for those who cannot pay. Sometimes the billing services grant discounts to people who offer to pay weaker amounts immediately, rather than paying the larger amounts over time.

Patients can also ask questions about payment of cash prices, which rather means the costs they would have incurred if they had no insurance, said Monahan, Georgetown expert. The cash price can be lower.

If this does not work, search for a health care defender in your condition, Waskowicz suggested.

“Insofar as it is possible, they are able to work with insurers to see if they can obtain these costs has been canceled,” he said.

In the meantime, stay in touch with the billing office, added Waskowicz. If you actively dispute the bill, the chances are lower than it is sent to the collections.

Kelmar said that if you cannot avoid installation fees and find it difficult to pay, do not put the balance on a credit card. Instead, develop a payment plan directly with the supplier, ideally with a low or no interest.

What to do before your next meeting

If you want to avoid installation costs in the future, try to find an independent doctor’s office that does not belong to a hospital.

It’s not always easy: in West Covina, California, Todd Bash, 60, needed injections for a spine problem and ended up being charged over $ 450 for a pain specialist. He then made dozens of calls trying to find another doctor who could administer the injections. But he said that all the doctors’ offices they contacted were affiliated with hospitals or had not taken his insurance.

“It was like full-time work trying to sail in the system and trying to get a price,” he said.

Bash finally found an independent clinic about 20 miles away which accepted his insurance and would administer the gunshots for $ 37. Then, last month, the doctor’s office stopped accepting insurance.

“I’m back to square one,” he said.

California has no books on books that approach installation costs. Experts say that more states are trying to adopt legislation that would limit costs, which could reduce patient bills in the future.

“It is more and more recognized that it is a problem and that consumers cannot afford it,” said Monahan.