WEBVTT
00:00:04.879 --> 00:00:06.400
Okay, here's the story.
00:00:06.559 --> 00:00:07.040
Listen.
00:00:07.360 --> 00:00:11.279
Same doctor I saw last year, same room, same forty minute appointment.
00:00:11.519 --> 00:00:15.119
Bill came in 50% higher than the one I paid last time I was there.
00:00:15.439 --> 00:00:16.000
Why?
00:00:16.160 --> 00:00:18.079
The hospital bought the doctor's office.
00:00:18.320 --> 00:00:19.519
Rewrote the paperwork.
00:00:19.679 --> 00:00:24.800
The same room I've been walking into for years is now a facility, and I get billed for being inside it.
00:00:25.039 --> 00:00:28.640
Last week I did the Charge Master, the world of the uninsured.
00:00:28.800 --> 00:00:31.440
This week, I'm gonna do the version for the rest of us.
00:00:31.600 --> 00:00:33.520
The version for the people who pay premiums.
00:00:33.679 --> 00:00:35.119
Here's how the trick works.
00:00:35.280 --> 00:00:37.200
The hospital buys a doctor's office.
00:00:37.359 --> 00:00:38.719
Nothing physical changes.
00:00:38.880 --> 00:00:41.920
Same exam table, same thermometer, same doctor.
00:00:42.079 --> 00:00:43.759
They just rewrite the paperwork.
00:00:43.920 --> 00:00:46.960
And on paper, it just became a totally different building.
00:00:47.200 --> 00:00:55.600
One paperwork change, one reclassification, one new bill that didn't exist before, same 40-minute visit, two bills instead of one.
00:00:55.759 --> 00:01:03.679
The doctor's bill, same as always, plus a brand new one called a facility fee for using the facility I've already been in before.
00:01:03.840 --> 00:01:05.599
The markup runs 40 to 50%.
00:01:06.079 --> 00:01:07.760
Same doctor, same 40 minutes.
00:01:07.920 --> 00:01:10.239
Bill goes from a thousand bucks to 1,500.
00:01:10.400 --> 00:01:12.079
Nothing physical changed.
00:01:12.319 --> 00:01:13.840
20% coinsurance.
00:01:14.000 --> 00:01:15.840
That's the average for outpatient visits.
00:01:16.000 --> 00:01:18.079
Two-thirds of insured workers pay it.
00:01:18.159 --> 00:01:21.840
And if you're sitting there thinking, I have insurance, this isn't my problem.
00:01:22.000 --> 00:01:22.799
Well, guess what?
00:01:22.959 --> 00:01:24.079
I got news for you.
00:01:24.239 --> 00:01:26.000
It is absolutely your problem.
00:01:26.159 --> 00:01:29.200
You've got the deductible applied separately to hospital charges.
00:01:29.280 --> 00:01:33.840
Plus on 13% of plans, a co-payment averaging$186 per visit.
00:01:34.000 --> 00:01:36.000
And that's the math, even when it goes well.
00:01:36.239 --> 00:01:39.040
Stateline reported these real bills, real people.
00:01:39.280 --> 00:01:42.400
Pediatric visit,$503 in fees.
00:01:42.719 --> 00:01:45.599
ADHD medication appointment,$488.
00:01:45.920 --> 00:01:49.200
Steroid injection for arthritis,$355.
00:01:49.519 --> 00:01:52.400
And sometimes your plan doesn't cover the facility fee at all.
00:01:52.560 --> 00:01:54.000
You owe the entire amount.
00:01:54.159 --> 00:01:56.319
And you don't find out until the bill arrives.
00:01:56.480 --> 00:02:00.400
Weeks after the visit, sitting in your mailbox like a surprise nobody asked for.
00:02:00.640 --> 00:02:01.920
Now I'll be straight with you.
00:02:02.159 --> 00:02:07.359
The American Hospital Association isn't wrong when they say insurers undermine facility fee coverage.
00:02:07.599 --> 00:02:11.520
The insurance industry isn't wrong when they say facility fees inflate costs.
00:02:11.680 --> 00:02:12.879
Both of those things are true.
00:02:13.120 --> 00:02:14.879
Neither side has to choose between them.
00:02:15.039 --> 00:02:16.479
The patient holds the gap.
00:02:16.639 --> 00:02:19.280
Now here's the thing about the phrase facility fee.
00:02:19.439 --> 00:02:22.800
It did not start in a hospital boardroom, not even close.
00:02:22.960 --> 00:02:28.639
Concert tickets, Ticketmaster, every venue you go to has a separate line item called facility charge.
00:02:28.800 --> 00:02:30.639
100% of it goes to the venue.
00:02:30.719 --> 00:02:31.680
They set the price.
00:02:31.840 --> 00:02:37.039
Average effective fees on a Ticketmaster purchase run 27% of the entire ticket cost.
00:02:37.199 --> 00:02:39.840
Sports tickets, same architecture, same name.
00:02:40.080 --> 00:02:47.759
Gyms have what they call annual facility maintenance fee,$50 to$100 tacked onto your monthly dues, charged once a year automatically.
00:02:47.919 --> 00:02:49.680
You sign up for$30 a month.
00:02:49.840 --> 00:02:51.520
The math says, well,$40.
00:02:51.840 --> 00:02:53.520
Concerts, sports, gyms.
00:02:53.759 --> 00:03:02.319
If I told you right now, Amazon just announced a facility fee for employees at their non-robot warehouses to cover the cost of providing lighting to humans.
00:03:02.479 --> 00:03:03.680
You'd pause, right?
00:03:03.840 --> 00:03:05.039
You'd have to check.
00:03:05.199 --> 00:03:07.199
Well, I'll tell you what you would find.
00:03:07.520 --> 00:03:11.280
Amazon's robotic warehouses run cooler than the non-robotic ones.
00:03:11.520 --> 00:03:12.000
Why?
00:03:12.240 --> 00:03:14.639
Because the robots overheat and stop working.
00:03:14.800 --> 00:03:21.840
The Strategic Organizing Center reported that robotic facilities have a 54% higher injury rate than non-robotic ones.
00:03:22.000 --> 00:03:22.879
Explain that.
00:03:23.039 --> 00:03:26.479
Not a facility fee yet, but the architecture is in place.
00:03:26.639 --> 00:03:28.639
Robots are protected because they're capital.
00:03:28.800 --> 00:03:30.639
Humans are managed because they're labor.
00:03:30.719 --> 00:03:34.000
And that's not parity, that's just a press release they haven't issued yet.
00:03:34.159 --> 00:03:35.039
So what do you do?
00:03:35.199 --> 00:03:37.280
You can't unreclassify the office.
00:03:37.439 --> 00:03:41.120
But before any visit, before any appointment, you got three questions.
00:03:41.360 --> 00:03:43.759
Is this visit billed as facility based?
00:03:44.000 --> 00:03:44.400
Two.
00:03:44.560 --> 00:03:47.439
If yes, will my insurance cover the facility fee?
00:03:47.599 --> 00:03:51.520
Three, can I get a good faith estimate in writing before I book an appointment?
00:03:51.759 --> 00:03:53.520
Good news is they have to answer.
00:03:53.680 --> 00:03:55.680
The good faith estimate is federal law.
00:03:55.840 --> 00:04:00.000
The other two are just questions, and they are not allowed to lie to you about either one of them.
00:04:00.240 --> 00:04:05.280
If the answer to the first one is yes and the answer to the second one is no, ask for cash price.
00:04:05.520 --> 00:04:08.560
Most of the time it's lower than what insurance would have paid anyway.
00:04:08.800 --> 00:04:10.080
Ask before you book.
00:04:10.240 --> 00:04:11.199
That's not advice.
00:04:11.280 --> 00:04:12.800
That's the only leverage you have.
00:04:12.960 --> 00:04:20.079
And next time my boss tries to charge me a facility fee for using the office bathroom, I'm asking for a good faith estimate first.
00:04:20.240 --> 00:04:23.439
Facility fees are just one fee in a giant category.
00:04:23.600 --> 00:04:25.519
We'll talk about all of them next week.
00:04:25.759 --> 00:04:28.079
Right now, I gotta go see my therapist.
00:04:28.240 --> 00:04:30.079
He charges a facility fee.
00:04:30.240 --> 00:04:32.000
And we meet on Zoom.
00:00:04.879 --> 00:00:06.400
Okay, here's the story.
00:00:06.559 --> 00:00:07.040
Listen.
00:00:07.360 --> 00:00:11.279
Same doctor I saw last year, same room, same forty minute appointment.
00:00:11.519 --> 00:00:15.119
Bill came in 50% higher than the one I paid last time I was there.
00:00:15.439 --> 00:00:16.000
Why?
00:00:16.160 --> 00:00:18.079
The hospital bought the doctor's office.
00:00:18.320 --> 00:00:19.519
Rewrote the paperwork.
00:00:19.679 --> 00:00:24.800
The same room I've been walking into for years is now a facility, and I get billed for being inside it.
00:00:25.039 --> 00:00:28.640
Last week I did the Charge Master, the world of the uninsured.
00:00:28.800 --> 00:00:31.440
This week, I'm gonna do the version for the rest of us.
00:00:31.600 --> 00:00:33.520
The version for the people who pay premiums.
00:00:33.679 --> 00:00:35.119
Here's how the trick works.
00:00:35.280 --> 00:00:37.200
The hospital buys a doctor's office.
00:00:37.359 --> 00:00:38.719
Nothing physical changes.
00:00:38.880 --> 00:00:41.920
Same exam table, same thermometer, same doctor.
00:00:42.079 --> 00:00:43.759
They just rewrite the paperwork.
00:00:43.920 --> 00:00:46.960
And on paper, it just became a totally different building.
00:00:47.200 --> 00:00:55.600
One paperwork change, one reclassification, one new bill that didn't exist before, same 40-minute visit, two bills instead of one.
00:00:55.759 --> 00:01:03.679
The doctor's bill, same as always, plus a brand new one called a facility fee for using the facility I've already been in before.
00:01:03.840 --> 00:01:05.599
The markup runs 40 to 50%.
00:01:06.079 --> 00:01:07.760
Same doctor, same 40 minutes.
00:01:07.920 --> 00:01:10.239
Bill goes from a thousand bucks to 1,500.
00:01:10.400 --> 00:01:12.079
Nothing physical changed.
00:01:12.319 --> 00:01:13.840
20% coinsurance.
00:01:14.000 --> 00:01:15.840
That's the average for outpatient visits.
00:01:16.000 --> 00:01:18.079
Two-thirds of insured workers pay it.
00:01:18.159 --> 00:01:21.840
And if you're sitting there thinking, I have insurance, this isn't my problem.
00:01:22.000 --> 00:01:22.799
Well, guess what?
00:01:22.959 --> 00:01:24.079
I got news for you.
00:01:24.239 --> 00:01:26.000
It is absolutely your problem.
00:01:26.159 --> 00:01:29.200
You've got the deductible applied separately to hospital charges.
00:01:29.280 --> 00:01:33.840
Plus on 13% of plans, a co-payment averaging$186 per visit.
00:01:34.000 --> 00:01:36.000
And that's the math, even when it goes well.
00:01:36.239 --> 00:01:39.040
Stateline reported these real bills, real people.
00:01:39.280 --> 00:01:42.400
Pediatric visit,$503 in fees.
00:01:42.719 --> 00:01:45.599
ADHD medication appointment,$488.
00:01:45.920 --> 00:01:49.200
Steroid injection for arthritis,$355.
00:01:49.519 --> 00:01:52.400
And sometimes your plan doesn't cover the facility fee at all.
00:01:52.560 --> 00:01:54.000
You owe the entire amount.
00:01:54.159 --> 00:01:56.319
And you don't find out until the bill arrives.
00:01:56.480 --> 00:02:00.400
Weeks after the visit, sitting in your mailbox like a surprise nobody asked for.
00:02:00.640 --> 00:02:01.920
Now I'll be straight with you.
00:02:02.159 --> 00:02:07.359
The American Hospital Association isn't wrong when they say insurers undermine facility fee coverage.
00:02:07.599 --> 00:02:11.520
The insurance industry isn't wrong when they say facility fees inflate costs.
00:02:11.680 --> 00:02:12.879
Both of those things are true.
00:02:13.120 --> 00:02:14.879
Neither side has to choose between them.
00:02:15.039 --> 00:02:16.479
The patient holds the gap.
00:02:16.639 --> 00:02:19.280
Now here's the thing about the phrase facility fee.
00:02:19.439 --> 00:02:22.800
It did not start in a hospital boardroom, not even close.
00:02:22.960 --> 00:02:28.639
Concert tickets, Ticketmaster, every venue you go to has a separate line item called facility charge.
00:02:28.800 --> 00:02:30.639
100% of it goes to the venue.
00:02:30.719 --> 00:02:31.680
They set the price.
00:02:31.840 --> 00:02:37.039
Average effective fees on a Ticketmaster purchase run 27% of the entire ticket cost.
00:02:37.199 --> 00:02:39.840
Sports tickets, same architecture, same name.
00:02:40.080 --> 00:02:47.759
Gyms have what they call annual facility maintenance fee,$50 to$100 tacked onto your monthly dues, charged once a year automatically.
00:02:47.919 --> 00:02:49.680
You sign up for$30 a month.
00:02:49.840 --> 00:02:51.520
The math says, well,$40.
00:02:51.840 --> 00:02:53.520
Concerts, sports, gyms.
00:02:53.759 --> 00:03:02.319
If I told you right now, Amazon just announced a facility fee for employees at their non-robot warehouses to cover the cost of providing lighting to humans.
00:03:02.479 --> 00:03:03.680
You'd pause, right?
00:03:03.840 --> 00:03:05.039
You'd have to check.
00:03:05.199 --> 00:03:07.199
Well, I'll tell you what you would find.
00:03:07.520 --> 00:03:11.280
Amazon's robotic warehouses run cooler than the non-robotic ones.
00:03:11.520 --> 00:03:12.000
Why?
00:03:12.240 --> 00:03:14.639
Because the robots overheat and stop working.
00:03:14.800 --> 00:03:21.840
The Strategic Organizing Center reported that robotic facilities have a 54% higher injury rate than non-robotic ones.
00:03:22.000 --> 00:03:22.879
Explain that.
00:03:23.039 --> 00:03:26.479
Not a facility fee yet, but the architecture is in place.
00:03:26.639 --> 00:03:28.639
Robots are protected because they're capital.
00:03:28.800 --> 00:03:30.639
Humans are managed because they're labor.
00:03:30.719 --> 00:03:34.000
And that's not parity, that's just a press release they haven't issued yet.
00:03:34.159 --> 00:03:35.039
So what do you do?
00:03:35.199 --> 00:03:37.280
You can't unreclassify the office.
00:03:37.439 --> 00:03:41.120
But before any visit, before any appointment, you got three questions.
00:03:41.360 --> 00:03:43.759
Is this visit billed as facility based?
00:03:44.000 --> 00:03:44.400
Two.
00:03:44.560 --> 00:03:47.439
If yes, will my insurance cover the facility fee?
00:03:47.599 --> 00:03:51.520
Three, can I get a good faith estimate in writing before I book an appointment?
00:03:51.759 --> 00:03:53.520
Good news is they have to answer.
00:03:53.680 --> 00:03:55.680
The good faith estimate is federal law.
00:03:55.840 --> 00:04:00.000
The other two are just questions, and they are not allowed to lie to you about either one of them.
00:04:00.240 --> 00:04:05.280
If the answer to the first one is yes and the answer to the second one is no, ask for cash price.
00:04:05.520 --> 00:04:08.560
Most of the time it's lower than what insurance would have paid anyway.
00:04:08.800 --> 00:04:10.080
Ask before you book.
00:04:10.240 --> 00:04:11.199
That's not advice.
00:04:11.280 --> 00:04:12.800
That's the only leverage you have.
00:04:12.960 --> 00:04:20.079
And next time my boss tries to charge me a facility fee for using the office bathroom, I'm asking for a good faith estimate first.
00:04:20.240 --> 00:04:23.439
Facility fees are just one fee in a giant category.
00:04:23.600 --> 00:04:25.519
We'll talk about all of them next week.
00:04:25.759 --> 00:04:28.079
Right now, I gotta go see my therapist.
00:04:28.240 --> 00:04:30.079
He charges a facility fee.
00:04:30.240 --> 00:04:32.000
And we meet on Zoom.
