The Facilty Fee at the New LGBT Center will be $100

[Bill Call]

That's according to someone I know who works at the Clinic. Most insurance companies will count that fee as part of your deductible.

[Bridget Conant]

That’s robbery.

[pj bennett]

Charging a facility fee is double-dipping. When the Cleveland Clinic began doing this, I immediately called my insurance company to complain.

https://www.cms.gov/medicare/coding/pla ... e_set.html

(I know that the link says Medicare, but the place of service codes apply for everyone, no matter their age. This is across the board, nationwide.)

Please note that all definitions for the various places of services begin with "a facility or location....."

Rates of reimbursement are determined by ‘place of service’. When you go to a doctor’s office for an exam, the place of service code is 11.

Let’s say, that you return to that office a couple of weeks later, and receive an injection for bursitis. The place of service is still 11.

But, if you go to an Urgent Care facility because of acute pain and receive the same injection, the place of service code will be 20. The rate of reimbursement for the same injection will be different, because one was administered in a doctor’s office, while the other was in an Urgent Care facility.

The Urgent Care facility cannot charge an extra fee because of its facility. The procedure is already being paid according to the place that the service was provided.

This logic applies towards all billing practices….. except the CC, because it makes up its own rules.

This fee began appearing on a friend’s bill some years ago. I called his insurance company and explained the situation.

At first, the insurance phone rep didn’t see the problem as I saw it. I persisted. I asked her about the place of service code and asked what was used. She said 11. I said, well.... isn't the rate determined by the place of service? If it's an 11, this proves that the procedure took place in a doctor's office. It took some doing, but bit by bit, she got it.

I suggested to her, that she look at another patient’s insurance claim, within my friend’s network, that was not a Cleveland Clinic claim. Was there a facility fee? Nope. There was not.

She took this very personally, and stressed to me, that my friend was never to pay for this fee. That if the CC threatened him with collection notices, that we were to call her.

I always check his EOB’s (explanation of benefits) to see what the insurance company is allowing vs. disallowing. It is important to do this, as it’s not unusual for the CC to bill for something that has been disallowed.

Never pay a CC invoice, unless the amount due matches the amount due, as according to your insurance company.

Interestingly, whenever I’ve had to call the CC about billing, the rep can never find the EOB.
One must be persistent.

Patients are responsible for paying the deductible, until it is met. Deductibles vary greatly.

Yes, this facility fee is robbery, and if folks don't check their EOB's and contact the insurance company, they will continue to be robbed.

I hope this helps someone. Sorry, if I got a bit wordy.... but, understanding coding can be a bit tricky.

[Bill Call]

This info came from a person who works at the Clinic in Avon.

The Clinic is notorious for hiding billing details. The entire medical industry is notorious for opaque pricing. If the car companies operated like the medical companies you wouldn't be able to find out the cost of your MRI until after you bought it.

Someone I know took themselves to the Lakewood "emergency room" because of some shortness of breath. When the ER doctor said that he should be hospitalized for observation they where told to take him the VA Hospital. He was taken to Lutheran.

Three days later he was released.

The Clinic billed $12,000 to the patient. The said that the bill was submitted to the VA and Medicare. Over the next several months this person starting receiving collection letters. After each collection letter was received the patient was told that the bills were submitted. I eventually got involved and started asking why he never received an itemized bill and why Medicare never sent an EOB. After an hour or so on the phone I was told that the bill was never submitted to Medicare or the VA.

Buyer beware!!!

Will customers at the new LGBT center be charged for parking? I know that the City has to invest at least $2.5 million in the new parking garage but I don't know if that buys the people of Lakewood free parking.

PJ, thanks for the info.

[Stan Austin]

Goes back to the cheap ass auto dealerships trying to bill for rags and oil.

[Amy Martin]

Bill - I would like to know why you repeatedly refer to the new Health Center as the New LGBT center . . .

[Bill Call]

Bill - I would like to know why you repeatedly refer to the new Health Center as the New LGBT center . . .

Excellent question!

This is from the Master Agreement regarding services at the new health center:
.5 Population Health Management Programs; LGBT Clinic.
4
11938585.11
(a) The FHC's activities will include a focus on population health
management programs aimed at improving the health of the FHC's patients and the community
that the FHC serves. The parties contemplate creating population health management programs
through partnerships with City government and the community related to outreach programs and
home health care models. As part of the commitment to population health management, the
Clinic and the City contemplate reporting population health statistics and metrics to the
community that have been compiled by the Clinic in connection with the FHC's operations.
While effective population health management programs are tailored to the specifics of the
demographics and needs of the particular community, the Clinic contemplates that the population
health management programs will (i) recognize and appreciate the diverse cultures in the
community, including LGBT and persons of various ethnicities; (ii) address the needs of those
with unique issues such as those in the senior population; and (iii) provide care for those who are
currently underserved. Population health management programs often consist of programs such
as population-based chronic disease management, specialty emergency services, group visits,
specialized programs/services/clinics, and prevention and wellness programs. Through the
development of care models and population health management programs through the FHC, the
Clinic will be developing future models for population health management for other
communities.
(b) LGBT is recognized as an underserved population with specialized health
needs, many rooted in primary care. As part of the population health model embraced by the
FHC, the Clinic will establish an LGBT-focused primary care clinic within the FHC. The Clinic
intends that the FHC will be its hub for LGBT care and referrals on the west side of greater
Cleveland. The Clinic contemplates that the Lakewood LGBT Clinic would (i) be structured to
meet the primary care needs of the LGBT population by providing individualized care, high
quality service, and proven efficiencies to remove barriers to the delivery of high quality health
care services that are related to sexual orientation and (ii) provide LGBT-welcoming primary
care and implement and measure the effect of proven quality and innovations.

Here is what it says about other services:

Due to the uncertainty regarding
and the potentially rapidly changing nature of the approach to delivering health care services, the
parties acknowledge that it will be necessary for the Clinic to continually re-evaluate the services
provided at the FHC. Part of the Clinic's process in monitoring and evaluation of health care
needs of the Lakewood community and its residents will include the Fairview Hospital
Community Health Needs Assessment, which will include a separate section on the City of
Lakewood. Therefore, based upon the Clinic's assessment utilization of health care services and
regulatory concerns, and in consultation with the FHC Community Advisory Board (defined
below), as appropriate, the Clinic may modify the services listed on Exhibit C as necessary to
address the results of such evaluation, subject to Section 2.4.

Nothing is guaranteed except the LGBT services. In its recent ad on Pandora the Clinic touted the opening of the new "LGBT clinic and other services" at the new Lakewood facility.

I don't have any problem with dedicated services for people with different health care needs. What about Lakewood's 7,000 children? What about Lakewood's 5,000 veterans? What about the elderly?

The new Healthy Lakewood Foundation excludes veterans as part of its diversity agenda. Why is that?