What is a facility fee?

A charge from the hospital or facility for the setting of your care — the room, staff, equipment and supplies — separate from the clinician’s own fee.

Why did I get a bill from a doctor I never met?

Some clinicians, such as radiologists or pathologists, review scans or samples without meeting you, and bill separately for that work.

Can an out-of-network doctor at an in-network hospital bill me more?

For emergencies and some non-emergency care at in-network facilities, the No Surprises Act protects most insured people from surprise out-of-network bills.

TWO BILLS

Why did I get two (or more) bills for one hospital visit?

Because the hospital and the clinicians who treated you often bill separately. The hospital’s bill covers the facility — the room, nursing, equipment and supplies — while doctors such as the emergency physician, anesthesiologist or radiologist may send their own “professional” bills.

Why it’s confusing

From the inside it felt like one visit, so a second bill from a company you have never heard of looks like a mistake or a scam. Often it is a physician group that works in the hospital but bills on its own.

Each bill also has its own EOB from your insurer, and they arrive at different times, so it is easy to lose track of what has been paid.

How to read it

Look at who sent each bill. A hospital or facility bill usually lists room, emergency department, lab, pharmacy and supply charges. A professional bill comes from a physician group and lists the clinician’s services, often with CPT codes.

Match each bill to the EOB with the same provider name and date of service. Each should have its own “you may owe” figure.

Check network status. Clinicians at an in-network hospital are not always in your network. For some care at in-network hospitals and for emergencies, the No Surprises Act limits what out-of-network providers can bill you.

What it does not mean

That you are being charged twice for the same thing. Facility and professional fees cover different parts of the care.
That an unfamiliar company’s bill is genuine just because it names the hospital. Match it to an EOB before paying.
That every bill from the same visit has the same network status.

Where you’ll see it

Separate statements from the hospital and from physician groups (emergency, anesthesia, radiology, pathology).
Separate claims on your insurer’s app or EOBs.

Questions worth asking

Ask the billing office on each bill

What service does this bill cover, and who provided it?
Has it been sent to my insurer?

Ask your insurer

How many claims are there for this date?
Was each provider in network?

Not sure what a second bill is for? Attach it, and Clariti will explain who sent it and what it covers.

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Common questions

What is a facility fee?: A charge from the hospital or facility for the setting of your care — the room, staff, equipment and supplies — separate from the clinician’s own fee.
Why did I get a bill from a doctor I never met?: Some clinicians, such as radiologists or pathologists, review scans or samples without meeting you, and bill separately for that work.
Can an out-of-network doctor at an in-network hospital bill me more?: For emergencies and some non-emergency care at in-network facilities, the No Surprises Act protects most insured people from surprise out-of-network bills.