Facility fees and the cortisone shot bill

“I wasn’t even observed. The doctor walked in and gave me a shot.”

That’s what a woman in Ohio told CBS News about a cortisone injection at a hospital-owned office. Her bill came to $2,667. Of that, $2,418 was a facility fee labeled an observation room charge. No observation took place.

A breast cancer survivor in North Carolina saw the before and after of a hospital buying a doctor’s practice. Same oncologist, same office, the same checkup she’d had for years. When the hospital bought the practice, her visit went from about $75 to about $400. The site got “reclassified,” but the care didn’t change. Only the price did.

These aren’t outliers. As hospitals buy up physician practices and rebill outpatient visits as hospital care, the same thing repeats. Higher facility fees, higher premiums, higher out-of-pocket costs.

Right now employers and plans often can’t tell where care was actually delivered. The claim doesn’t have to say.

The Transparency in Billing Act of 2026 would change that. It amends ERISA to require off-campus hospital outpatient departments to carry a unique identifier on their claims. No identifier, the plan doesn’t pay and the hospital can’t bill the patient. The House Education and Workforce Committee passed it unanimously last month.

It doesn’t fix hospital pricing. But you can’t manage a cost driver you can’t see, and right now this one hides on the claim.

NABIP is backing H.R. 8684 and asking members to weigh in with their representatives. It takes about two minutes.

What’s your facility fee story?