AURORA, Colo. (KDVR) — Colorado hospitals say they can’t survive without facility fees but some patients say they may avoid medical care because they can’t afford the rising cost of facility fees.

A controversial measure, House Bill 23-1215, to limit facility fees will have its first hearing at the state Capitol on Friday.

Aurora mom Natalie Zelinska will watch closely after receiving a $1,525 facility fee following her 4-year-old son’s November 2022 appointment at Children’s Hospital Colorado.

“We need to monitor his heart condition all the time. One to two times a year just to see where he is,” Zelinska said, who previously took her son to Denver Health Medical Center for bi-annual electrocardiograms and ultrasounds.

When her pediatric cardiologist moved to Florida, he suggested the Zelinksas seek care at Children’s Hospital Colorado.

Bills reviewed by the Problem Solvers showed the facility fee at Denver Health was $55 but for essentially the same service at Children’s Hospital, Zelinksa received a facility fee of $1,525.

“If I knew that it that would be so expensive, I would just buy the ticket to Florida and we’ll see our previous doctor,” Zelinksa said.

She also asked investigative reporter Rob Low if he would charge her to be interviewed. “Yes. Now, I ask that question all the time before I get service,” she said with a laugh.

Her experience of receiving what she felt was an extraordinarily high facility bill without warning is something that’s been highlighted by numerous Problem Solvers stories last year.

Problem Solvers investigate facility fees

The Problem Solvers’ investigation into facility fees began with Michael Kark, a Greenwood Village dad whose son’s therapy session came with an extra $500 facility fee. “There was literally just a lamp and a couch,” Kark remembered.

His story was followed by Brittany Tesso in Aurora who shared her $847 facility fee bill for her son’s telehealth visit. “I was like, ‘facility fee?’ I didn’t go to your facility,” Tesso said.

Then there was Colorado Springs dad Ben Los, who received a $2,518 facility fee bill for his son’s brain scan. “If you can get away with it and you can make more money, it seems like that’s that’s what the hospital’s going to do,” Los said.

“I don’t think the bills have skyrocketed. Do I think they’ve gone up in the last year? Probably,” Julie Lonborg, the vice president of communications for the Colorado Hospital Association, said.

Lonborg said facility fees pay for everything but the doctor’s bill, so they cover the cost of nurses, surgical technicians, janitors, expensive equipment, utility bills and so forth.

But facility fees aren’t just charged at hospitals, patients are increasingly facing them at any doctor’s office or outpatient clinic.

Doctor disagrees with facility fees, hospital association defends them

“I think they’re horrible,” Dr. John McLaughlin said, a family medical physician who’s operated his practice in Aurora for 30 years without ever charging his patients a separate facility fee.

“If you’re a hospital system, you own that practice, you can add a $200 or $300 fee.
That’s just literally for breathing the air. They didn’t do anything different than I do,” McLaughlin said, who added he pays for his medical staff and equipment out of his provider fee.

According to the Journal of Health Economics, 70% of doctor practices have been bought up by hospitals or private equity firms and as they did, facility fees were added, forcing patients to pay more for essentially the same service.

When asked if he thought facility fees were a way for hospitals to pad their bottom line, he didn’t hesitate, “Well sure, of course.”

But Lonborg said that’s not a fair criticism for hospitals, “No, not at all. Again, those fees are scaled based on the care that’s provided.”

Bill in legislation to ban, cap facility fees

Under House Bill 23-1215, facility fees would be banned in some circumstances.

The measure would prohibit facility fees for telehealth visits, primary care visits and preventative care visits.

The bill would also mandate the state seek an independent report on hospital facility fees. According to Kachina Weaver, a lobbyist for the bill, the independent study is needed because “reliable third-party data will help us all understand the true impact of these fees on patients and hospitals as well as the mechanisms through which hospitals cover costs.”

The newly revised measure would still demand transparency, meaning future facility fees would require patient notification at the time of service, something Zelinksa wishes she had before she took her 4-year-old son for his cardiology appointment.

“People should know upfront. If we go to the supermarket, we see the bread costs $2 or $10 or $50 and we buy it or not buy it,” she said.

“Hospitals and the practices that work with us are committed to transparency,” Lonborg said, but she added any additional limits on facility fees could force hospitals to close clinics and reduce patient access to medical services.

“This has the potential to have devastating catastrophic consequences to the patient care system in Colorado,” Lonborg insisted.

But McLaughlin told the Problem Solvers it’s the rising facility fees that are having catastrophic consequences for patients.

“The longer that outpatient facilities fees become accepted and part of the practice, the less likely we will ever go back. This would just be another cost to the working class that they just have to take,” he said.

Zelinska said she will not take her son back to Children’s Hospital in Colorado for his next cardiology follow-up.

“No. I will ask for the quote before. I did not do that before we went to the Children’s Hospital and I regret it. So I will surely research more about where we can have our next appointment at and we will ask for the estimate before,” she said.

In an email, Children’s Hospital Colorado told FOX31 that Zelinska could have sought an estimate ahead of her last appointment but even if she had, Zelinska discovered after the fact that the estimate for her facility fee would’ve been $980 — far more than she would’ve expected — but as it turns out, a lot less than the $1,525 she was actually billed.

“I found that estimate accidentally by myself after all bills were already sent to me,” Zelinksa said.

Statement from Children’s Hospital

Children’s Hospital Colorado provided FOX31 with the following statement:

It’s important to us that our patients and families understand the cost of care in our health system. We take every patient concern seriously and our team works through those concerns to elevate them as appropriate.

As a pediatric specialty hospital provider, we are committed to price transparency and enhancing our functionality to better meet the needs of our patients and families. To do this, we provide cost estimate information in advance for scheduled outpatient care and review our billing practices at least annually to make changes where necessary to continually improve the experience of our patients and families. On demand cost estimates are available for a majority of services through our cost estimate tool. 

Parents want the highest quality care when they have a child who is ill or injured. Many families have come to expect to rely on the pediatric, specialized, integrated care available at Children’s Colorado, which is why fees may differ between healthcare facilities. 

“Facility fees” at Children’s Hospital Colorado cover the costs of running a comprehensive, integrated children’s hospital system from nurses to social workers, pharmacists, and front-desk teams. At every step along the way, we strive to treat the unique needs of every child and their family. 

Colorado hospitals have already scored a partial victory when it comes to HB23-1215. One section to eliminate facility fees at any off-campus clinic owned by a hospital — any facility more than 250 yards from a hospital’s main campus — has been removed. It is off-site locations, where hospitals have been collecting much of their facility fee revenues.