Testimony for SB 1232 to rein in unfair facility fees

Testimony before the Texas Senate Committee on Health and Human Services on April 8, 2025

My name is Rachel Carnahan-Metzger. I am a Pediatric Hospice and Palliative Care Social Worker and have worked with children with serious illness and their families for fifteen years. 

Today, I am a volunteer for TexPIRG, a statewide nonprofit, nonpartisan advocate for consumers.  We support SB 1232 as an important first step in protecting patients from the added cost of facility fees, which can add hundreds of dollars to a patient’s bill, without additional service or benefit.  Patients shouldn’t be charged additional fees simply because they were treated in a health care setting owned by a hospital. 

We urge you to vote YES on this bill to increase transparency around facility fee charges and to ban their use for telehealth appointments.  We are, however, disappointed that amendments have eliminated facility fee protections for preventive care. Studies confirm that out-of-pocket charges like facility fees, discourage patients from seeking care, which ultimately leads to worse health outcomes and increased costs. 

TexPIRG has heard from patients about the impact these fees have on their finances and health care decisions. As they were unable to join us, I want to share the stories of two patients from the Dallas area. 

Corinna booked an appointment at an oncology center after concerning lab results. Careful about her budget, she asked for and received written notice that she would only be charged her $180 copay. During her visit she got a PET scan, and was stunned to get her bill –  $392 – more than double what she had expected. After multiple calls, she learned that the floor the PET scan machine was on is owned by a hospital who charged a facility fee, even though she had received only outpatient care.

We also spoke with Brian. He was repeatedly charged a facility fee of over $100 for each of his multiple doctor appointments. Prior to receiving his first bill, he knew that preventive care was covered at no cost to him. He contested the fee, but was told that the doctor’s office, as part of a hospital system, was legally allowed to charge this fee. Now, Brian avoids the doctor altogether, knowing he cannot afford it. He can’t switch doctors to avoid fees because his local hospital system owns most of the practices in his area. He says that the issue “is causing more disappointment and emotional conflict in [his] life than [he] ever thought possible.”

These are two of the hundreds of patients who are charged facility fees simply because their provider is owned by a hospital system. We thank the sponsor and committee for bringing this bill as an important first step towards protecting patients from telehealth facility fee bills, and TexPIRG  urges you to VOTE YES.  We also encourage you to expand this legislation to ban facility fees for preventive care and all other appointments. Thank you for your time.