Legislature whiffs on banning hospital facility fees

The Texas legislature could have protected us from high health care charges, but failed.

After hearing from Texas patients about expensive add-on “facility fee” charges for their doctor visits, TexPIRG worked with bipartisan health leaders in the Texas legislature to put an end to this billing practice. TexPIRG volunteer, Rachel Carnahan-Metzger testified before the Senate committee and we urged patients to call their legislators. We thought we were on the road to victory. But sadly, the bill never came to a full vote and now patients across the state will continue to be billed these extra charges. 

Here’s how a patient can find themselves with a large, unexpected and unnecessary, facility fee. 

Corinna had an appointment at an oncology center to address  concerning signs in her bloodwork. She deliberately chose a non-hospital facility to lower the costs of her care. Careful about her personal budget, before booking the appointment, she asked for and received written notice that she would only face her copay charge: $180. During her visit she got a PET scan, which was completed on a different floor but in the same building. She was stunned to get her bill –  $392 – more than double what she had expected. It turns out the PET scan machine was located on a floor that was owned by a hospital. As such, she was charged a hospital facility fee, even though she had received only outpatient care.

Facility fees are a growing source of frustration — and expense — for patients. 

Hospital facility fees used to be limited to in-patient bills. They arguably offset the unique costs, such as 24-hour nursing care or ICUs, at a hospital facility. Now, patients in Texas find these fees on bills even when they never stepped foot inside a hospital.

That’s because when hospitals buy local physicians’ practices, they add these “hospital” charges to bills from affiliated doctors in non-hospital locations. 

Fees of $30-$250 quickly add up when tacked onto routine services, such as blood tests, X-rays or even telehealth visits, all without the patient’s knowledge. 

We know added charges negatively impact people’s care: in 2024, 63% of Texas adults skipped or delayed some form of medical care due to costs.

Patients face hundreds of dollars of added facility fees.

Brian, another patient who reached out to TexPIRG, explained the problem he faces. He is repeatedly charged a facility fee of over $100 out-of-pocket for each of his multiple doctor appointments. He contested the facility fee bill over phone and by email, but was told that the doctor’s office, as part of the hospital system, was legally allowed to charge a facility fee, despite the fact he never stepped foot in the hospital.

He told us he avoids the doctor altogether, knowing he cannot afford the high facility fees. He said that the issue “is causing more disappointment and emotional conflict in [his] life than [he] ever thought possible.”

No patient billing protections for Texans this year. 

The Texas legislature could have begun to fix this expensive problem. SB 1232 / HB 2556 are bipartisan legislation that would protect consumers against unfair “facility fees” added to telehealth bills in Texas. The legislation would also require facilities to give 10-day advance notice of any facility fees, ensuring patients don’t get caught off guard. 

Texas would have followed the lead of several other states that ban facility fees for telehealth appointments. 

We had a diverse coalition urging our elected officials to enact this sensible patient billing protection: TexPIRG, Americans for Prosperity, AARP and the Small Business Majority and many more. But this time, the hospitals got their way. They can keep charging patients hospital charges even when they are just visiting their regular doctors, and even if they just have a telehealth appointment. 

The Legislature won’t meet again until 2027, but we won’t stop working until this overbilling is stopped and Texans are protected from facility fees for medical care in a non-hospital setting.