{"id":494778,"date":"2026-10-13T15:50:08","date_gmt":"2026-10-13T15:50:08","guid":{"rendered":"https:\/\/www.newsbeep.com\/us-ca\/494778\/"},"modified":"2026-10-13T15:50:08","modified_gmt":"2026-10-13T15:50:08","slug":"hidden-fees-cost-michigan-patients-millions-lawmakers-push-reforms-the-oakland-press","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us-ca\/494778\/","title":{"rendered":"Hidden fees cost Michigan patients millions. Lawmakers push reforms \u2013 The Oakland Press"},"content":{"rendered":"

This story was originally published<\/a> by Bridge Michigan, a nonprofit and nonpartisan news organization. Sign up for a free newsletter at bridgemi.com\/signup<\/a><\/p>\n

By Robin Erb, Bridge Michigan<\/p>\n

Health systems add \u2018facility fees\u2019 to bills for services at off-site facilities \u2014 charges that they say help cover costs for the larger system
\nThat means some patients are charged more for care, even when the care, itself, hasn\u2019t changed
\nBut some worry an effort to limit those fees, though, would further strain hospital budgets, forcing some to close<\/p>\n

Michiganders are paying millions of extra dollars in healthcare bills each year, often paying to help operate hospitals they\u2019ve never even visited.<\/p>\n

There\u2019s no way to tell precisely how much they\u2019re paying: \u201cFacility fees<\/a>\u201d are usually buried deep in bills, and hospitals aren\u2019t required to publicly disclose how much they collect from them.<\/p>\n

The fees traditionally cover costs associated with healthcare like laundry, computer networks and security. Hospitals say they need the money to stay afloat and are increasingly adding the charges to outpatient services, such as labs and physicians\u2019 offices.<\/p>\n

But they don\u2019t disclose many basic details about the fees, prompting a bipartisan push for reform. In Lansing, legislation<\/a> would prohibit the fees when care is provided at sites outside of hospitals, telemedicine appointments and some in-hospital outpatient services.<\/p>\n

The legislation came after state Rep. Curt VanderWall, R-Ludington, requested an itemized bill for a routine blood test. He said he had heard from constituents about their bills increasing after their doctors\u2019 offices and labs were purchased by large healthcare systems.<\/p>\n

A single draw yielded three vials of blood to be tested, VanderWall said.<\/p>\n

\u201cI was shocked to see that I was charged a facility fee for each vial of blood that was drawn \u2014 nearly an extra $75 just for that one case of the blood draw,\u201d he told fellow lawmakers<\/a> in August.<\/p>\n

\"BridgeBridge Michigan<\/p>\n

Facility fees added an average of $100 to primary care doctor bills in 2022, according to one estimate<\/a>. While no reliable statewide estimate exists, the fees alone for Medicaid are easily tens of billions of dollars, according to a federal report.\u00a0\u00a0<\/a><\/p>\n

States including Ohio and Indiana<\/a> have begun limiting how hospitals can charge the fees, while others are debating legislation to cap them, increase transparency or require \u201csite-neutrality<\/a>\u201d so charges remain the same across hospital facilities, according to the Center on Health Insurance Reforms at Georgetown University.<\/p>\n

Since 2010, Rhode Island has limited annual increases of facility fees, which a Brown University study<\/a> concluded slowed the growth of the state\u2019s hospital charges by 9% compared with other states and slowed consolidation, but it cost hospitals $160 million.<\/p>\n

Hospitals contend the charges<\/a> are crucial to their survival. They typically operate at thin profit margins \u2014\u00a02.6% nationally last year<\/a> \u2014\u00a0and 33 Michigan hospitals either lost money or operated at a 0% margin in 2024, the most recent year for which data was available, according to d the National Academy for State Health Policy<\/a>, a Washington DC nonprofit.<\/p>\n

Since then, three of those facilities \u2014 hospitals in Sturgis<\/a>, East China and Ontonagon \u2014 have closed.<\/p>\n

Some lawmakers say that more could follow if facility fees are restricted.<\/p>\n

\u201cThis could destabilize even more institutions within the Upper Peninsula that are standalone and are literally struggling to keep the doors open,\u201d state Rep. David Prestin, R-Cedar River, said at a hearing in August.<\/p>\n

\u201cI worry that this could be a tipping point for even more.\u201d<\/p>\n

\u2018Black box\u2019 of costs<\/p>\n

It\u2019s difficult to measure the extent to which facility fees drive individual medical bills and even overall healthcare costs.<\/p>\n

Michigan\u2019s largest hospital systems would not disclose how much they collect, despite repeated requests from Bridge Michigan.<\/a><\/p>\n

The state does not track the fees, nor does the state\u2019s hospital association, according to spokespersons of both.<\/p>\n

But experts said there are some clues that the costs are significant.<\/p>\n

Typical nonemergency visits to a doctor cost $43 extra in a hospital-based outpatient department compared with a non-hospital physician\u2019s office in 2022, according to a review<\/a> by the Health Care Cost Institute.<\/p>\n

It found<\/a> that hospital-based labs charged more than three times more for tests than independent labs or physicians offices in employer-sponsored healthcare plans.<\/p>\n

The fees may go unnoticed by many patients because insurance picks up the costs.<\/p>\n

If patients notice an increase in charges, it can be hard to break down a medical bill \u2014 let alone research fees ahead of time, said Bret Jackson, CEO of the Economic Alliance of Michigan<\/a>, a Novi-based nonprofit focused on the state\u2019s economy and healthcare.<\/p>\n

He calls healthcare bills a \u201cblack box.\u201d<\/p>\n

\u201cIf you really dig your heels in, if you really fight back and are willing to go through phone call after phone call, and beat your head against the wall, maybe eventually \u2014 and it does happen \u2014 people can eventually get what they\u2019re looking for,\u201d he said.<\/p>\n

All too often, information is \u201csimply not available\u201d to consumers, Jackson said.<\/p>\n

Push for transparency<\/p>\n

Price transparency has become an issue in the governor\u2019s race, with both Democrat Jocelyn Benson and Republican John James saying they would require hospitals to disclose costs upfront to patients.<\/p>\n

A current US representative, James sponsored the Patients Deserve Price Tags Act<\/a> last year that would require hospitals to publish \u201cclear, upfront information<\/a>\u201d about pricing.<\/p>\n

Benson has said she wants to create an online portal<\/a> to report hospitals that don\u2019t disclose costs. She would empower the Michigan Department of Health and Human Services to handle complaints \u2014\u00a0and refer violators to the attorney general.<\/p>\n

Even so, efforts to boost transparency have proven lackluster nationwide.<\/p>\n

The U.S. Centers for Medicare & Medicaid Services requires<\/a> hospitals to make public \u201cmachine-readable\u201d prices.<\/p>\n

They\u2019re often listed through billing codes and jargon that make deciphering them difficult for consumers, said Shoshi Preuss, a state advocacy manager for United States of Care<\/a>, a Washington DC-based nonprofit that tracks federal and state health policies.<\/p>\n

Fewer than 1 in 5 hospitals owned by the nation\u2019s largest health systems \u2014 and 10 of 46 in Michigan \u2014 make clear the costs for at least half of their posted items and services, according to a review<\/a> last month by PatientRightsAdvocate.org<\/a>.<\/p>\n

This summer, the Trump administration warned more than 500 of the nation\u2019s hospitals, including 13 in Michigan<\/a>, that they were failing to provide the public with basic pricing information<\/a>, according to an Associated Press news report<\/a>.<\/p>\n

This month, the Federal Trade Commission sent warning letters<\/a> to 24 of the \u201cnation\u2019s largest healthcare services companies\u201d reminding them of their obligations.<\/p>\n

The letters did not explicitly state the recipients violated the rules, nor did the Trump administration name the 24 companies.<\/p>\n

Part of the problem is that there is no simple way to be transparent, Josh Traylor, a former health policy expert at the US Center for Medicare & Medicaid Innovation<\/a> and now executive director at the Center for Health and Research Transformation<\/a> at the University of Michigan.<\/p>\n

\"BretBret Jackson, president and CEO of the Economic Alliance of Michigan, said healthcare costs for his small organization will surge more than 19% this year, driven by facility fees and other costs in the \u201cblack box\u201d of healthcare financing. (Robin Erb\/Bridge Michigan)<\/p>\n

Costs for a service or procedure don\u2019t just vary from facility to facility \u2014 but also from insurer to insurer and from plan to plan within the same insurer.<\/p>\n

\u201cBlue Cross might have 10 different prices for a knee replacement,\u201d he said.<\/p>\n

And insurers and hospitals carefully guard the details of their contracts, Traylor said.<\/p>\n

With some exceptions, like this page<\/a> by the University of Michigan Health, finding prices for care isn\u2019t a simple click or two. Hospitals instead suggest consumers call for pricing or use their tools to input insurance policies.<\/p>\n

That allows more precise and accurate pricing, because it incorporates a patient\u2019s insurance coverage.<\/p>\n

Healthcare is \u2018wildly complex\u2019<\/p>\n

Facility fees have been charged for years \u2014\u00a0and limiting them now could threaten hospitals when they face multiple challenges, said Elizabeth Kutter, a vice president at the Michigan Health & Hospital Association.<\/p>\n

\u201cHealthcare is wildly complex,\u201d she said. Likewise, \u201cfinancing healthcare is wildly complex,\u201d she added.\u00a0<\/p>\n

The fees help cover costs that aren\u2019t obvious in care: electronic medical records and cybersecurity, laundry and janitorial staff, and round-the-clock, doctors and nurses even when business is slow.<\/p>\n

\"Four-panelThe Michigan House health policy committee is considering legislation that would limit facility fees that are charged by health systems for care at facilities that are off-site from their main campuses. State Rep. Curt VanderWall, R-Ludington, sponsored the bill. (Robin Erb\/Bridge Michigan)<\/p>\n

The charges offset rising costs of drugs and other healthcare costs, advocates say.<\/p>\n

Limiting the fees could cost hospitals nationwide as much as $180 billion<\/a> over 10 years, according to the American Hospital Association. Over that same period, the federal government anticipates some $655 billion in cuts to Medicaid<\/a>.<\/p>\n

Rural hospitals are some of the most at risk, because low volumes of patients and a shortage of providers add uncertainty to already-thin budget margins.<\/p>\n

\u201cPeople think hospitals make insane amounts of money because they see new equipment or new facilities, but that\u2019s really what is required to continue to offer high-quality care to patients and what they expect,\u201d said Ross Ramsey, CEO of Scheurer Health in Pigeon at the tip of the Thumb along Lake Huron.<\/p>\n

The hospital expects to collect $125,000 in facility fees this year to stretch its $125 million budget.<\/p>\n

The hospital is staffed during slow times and offers outpatient sites so patients don\u2019t have to drive an hour or more for routine care like physical therapy.<\/p>\n

The fees offset costs that aren\u2019t obvious to many patients, such as free translation services to non-English speaking residents that are required by law, cleaning of janitorial supplies and maintaining backup generators to operate the hospital.<\/p>\n

\u201cWe\u2019re not adequately reimbursed for these types of things, so that\u2019s why (we) need to make it up elsewhere,\u201d Ramsey said.<\/p>\n

Patients, he added, \u201cdon\u2019t realize how tight of a tight walk we already walk on a good day.\u201d<\/p>\n

\u2014 (Editor\u2019s note: The Michigan Health & Hospital Association is a funder of Bridge Michigan. It was not involved in the reporting or editing of this story.)<\/p>\n","protected":false},"excerpt":{"rendered":"This story was originally published by Bridge Michigan, a nonprofit and nonpartisan news organization. Sign up for a…\n","protected":false},"author":2,"featured_media":494779,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[1570,181,795,16663,100,143,145,144],"class_list":["post-494778","post","type-post","status-publish","format-standard","has-post-thumbnail","category-oakland","tag-health","tag-latest-headlines","tag-michigan","tag-michigan-news","tag-news","tag-oakland","tag-oakland-headlines","tag-oakland-news"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/posts\/494778","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/comments?post=494778"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/posts\/494778\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/media\/494779"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/media?parent=494778"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/categories?post=494778"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/tags?post=494778"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}