Americans are being charged sneaky fees for routine health care, sometimes hundreds of dollars. Here's why it's happening and what you can do about it

This is happening to patients whose regular physician’s office or clinic is owned by a hospital, even if they’re not located in one. As WFTV Channel 9 reports, the charges show up as “hospital facility fees” (1).

“They’re going to the same doctor in the same building, same boring waiting room, but now unbeknownst to them, that physician practice is owned by a hospital system,” Patricia Kelmar, with U.S. Public Interest Research Group (PIRG), told the media outlet.

These facility fees can add anywhere from tens to hundreds of dollars to routine medical care.

PIRG’s recent report, Outpatient Outrage 2026, found that these fees generate hundreds of millions of dollars in additional revenue while offering no clear added benefit to patients (2).

Rebecca Smith, a breast cancer survivor in Mooresville, North Carolina, was shocked the first time she was hit with a $400 bill for an office visit and blood draw that normally cost $75. This happened after a hospital system bought her local oncology practice.

“It was like a bait-and-switch,” Smith told WFAE 90.7 (3). “I’m having the same follow-up appointment I always have — and then, all of a sudden, they changed the billing. I felt like what they did was really dirty.”

Here’s what’s behind the fees and how to protect yourself.

What’s driving these unexpected charges

Facility fees were originally designed to help hospitals cover operating costs of emergency rooms, intensive care units and other around-the-clock services running out of hospitals themselves.

But over time, hospitals started applying these charges to facilities beyond hospital walls.

Today, when hospitals acquire physician practices outside the hospital they can bill insurers and patients at higher “hospital” rates, even when the care hasn’t changed.

Mary Mayhew, president and CEO of the Florida Hospital Association, argues that facility fees help fund broader access to care, noting that proximity to care matters, particularly in fast-growing regions like Central Florida.

“Our hospitals are really not just hospitals anymore,” she told WFTV. “They are health systems, and these health systems are trying to preserve access to an array of community-based services.”

But consumer advocates counter that patients shouldn’t shoulder higher costs for routine care simply because of consolidation, especially when prices aren’t transparent upfront.

They’re asking lawmakers to prohibit facility fees for routine outpatient care, require clearer public reporting and adopt site-neutral payment policies (patients pay the same price for the same service regardless of location).

To date, 21 states have passed some form of legislation around the fees.

The federal No Surprises Act, which took effect in 2022, limits certain unexpected out-of-network bills, particularly for emergency care.

Unfortunately, it doesn't prohibit facility fees for outpatient services at hospital-owned clinics.

That means for now, outpatients face higher out-of-pocket costs, particularly for those with high deductibles or co-insurance.

How to protect yourself from hospital facility fees

While policymakers debate reforms, patients aren’t powerless.

There are several things you can do to avoid or minimize surprise healthcare fees:

Ask upfront whether a provider charges a facility fee and whether the office is owned by a hospital system.