We once knew the basic rules of medical billing. You went to the hospital and paid for the room. You went to the doctor and paid for their time. In 2026, those lines have been deliberately erased. Hospital systems are aggressively acquiring independent physician practices. They are legally permitted to flip the signage on the door. Your local family practice is now a “Hospital Outpatient Department.”
This administrative trick allows them to charge two bills for one visit. You pay the standard “Professional Fee” for the doctor. You also pay a hidden facility fee for walking into the room. This cover charge can range from $150 to $500 for a routine checkup. These fees often fall under your high deductible rather than your flat office copay. Here are the ways hospitals are adding these fees to your routine care this year.
The Provider-Based Clinic Flip
The most common trap is now at your specialist’s office. You might see a cardiologist at the same location you have visited for years. But a local hospital system bought the practice last month. It is now designated as “Provider-Based.” You receive a bill for the doctor’s time plus a separate facility charge. This fee can exceed $200 for the “clinic visit.” You often won’t know this happened until the bill arrives. The only warning sign might be a small plaque on the wall. It states the location is a department of the hospital.
The Telehealth Originating Site Fee
Facility fees have gone virtual in 2026. Your doctor may work for a large health system. They bill your video call as if it “originated” from the hospital main campus. You may see a line item for an “Originating Site Facility Fee” on your bill. The CMS rate for this fee is roughly $31.85, but private plans charge more. This adds cost to a call that should have been a simple copay. Hospitals argue that the secure patient portal counts as a facility.
The Urgent Care ER Rebranding
That new urgent care center might not be an urgent care. Hospitals are opening satellite centers and licensing them as Freestanding Emergency Departments. They look like urgent cares but bill at ER rates. A visit for a sore throat can cost $1,200 instead of $150. They charge a “Level 3 Emergency Facility Fee” just for walking in. Watch the signage on the building carefully. If the word “Emergency” appears anywhere, you will be charged a facility fee.
The Tech Component on Imaging
Independent imaging centers are disappearing rapidly. Hospitals buy the local MRI lab and switch to “Split Billing.” You used to pay a global fee of perhaps $400. Now you get two separate bills. One is a “Professional Component” for the radiologist. The other is a Technical Component for the use of the machine. This technical fee can exceed $2,000. If you haven’t met your deductible, you pay the full amount.
The Observation Room Charge
You might go to the hospital for a minor procedure like an infusion. You are placed in a recovery room for an hour. Hospitals are aggressive about billing this wait time as “Observation Services.” You can be charged an hourly facility rate for the chair you sit in. This can add hundreds of dollars to a minor outpatient procedure. This is often billed in addition to the procedure room fee. It essentially double-dips for the space you occupied.
Ask the Freestanding Question
The only way to avoid these fees is to ask the right question. Do not ask if they take your insurance. Ask explicitly if the location is billed as a hospital department. If they say yes, ask for an estimate of the facility fee in writing. If they cannot provide it, look for an independent physician. In 2026, the building you walk into matters just as much as the doctor you see.
Did you get hit with a “Room Charge” for a simple doctor’s visit? Leave a comment below—share the name of the health system to warn other patients!
You May Also Like…
Read the full article here
