Kelly Brignac, photographed here at her Waterville home on Tuesday, was charged a $1,500 medical fee at MaineGeneral after undergoing an emergency room ultrasound for a miscarriage caused by pregnancy complications. Brianna Soukup/Staff Photographer
Obstetrician Kelly Brignac’s office was closed on a Friday afternoon in early May when she began bleeding due to complications early in her pregnancy.
Feeling she had no other choice, the 34-year-old from Waterville went to the emergency room at MaineGeneral Medical Center in Augusta. Hospital staff performed an ultrasound and blood test and sent her home with instructions to contact her doctor.
She suffered a miscarriage at home that same evening.
When she received the hospital bill, Brignac was shocked to find that she had to pay more than $2,000. She had to pay out of pocket because she had not yet reached her deductible.
Upon closer inspection, Brignac noticed a bill for $1,544 that was not related to any specific procedure or test. The hospital later confirmed it was a so-called facility fee, said Brignac, who also showed the Press Herald a copy of her bill.
Hospitals charge such fees to cover their general operating costs, but they are often not covered by health insurance and are often a surprise to patients.
“I felt like I was being taken advantage of,” said Brignac, a professor at Colby College. “I had no idea I was going to be charged so much. I got a bill for $2,000 that was basically just the doctors telling me, ‘Well, you’ll have to wait and see.'”
Brignac said she was not criticizing the treatment she received at the hospital, just that the bill was so high compared to the limited services she received at the emergency room. The ultrasound, blood work and other incidentals cost about $600, and she did not dispute those costs.
Brignac said she paid the bill only reluctantly.
A Press Herald investigation found that Brignac’s experience is common among patients seeking treatment at state hospitals, which sometimes hide treatment fees in medical bills without explanation. And insurance companies sometimes refuse to cover them, leaving patients to pay hundreds of dollars in unexpected costs simply for going to a hospital instead of getting care from another provider.
Joy McKenna, a spokeswoman for MaineGeneral Medical Center, said she would not comment on a specific case due to privacy concerns. But she said a facility fee is a standard charge for all patients treated at the hospital.
“Hospitals are generally subject to the federal anti-bribery and anti-corruption law and the civil monetary penalties law, which generally prohibit the waiver or reduction of fees, including facility fees, for individual patients,” McKenna said.
McKenna said the facility fee “covers the additional costs of care provided in the hospital or hospital outpatient department and is independent of the care provided to the patient by medical personnel.”
The focus of the investigation
Facility fees have been the focus of scrutiny and debate in the Maine state legislature since 2022, when the Press Herald highlighted patient complaints about the fees in an article about the country’s byzantine system of medical billing.
Troy Jackson, Democrat of Allagash, the president of the Maine State Senate, proposed a strong cap on fees, arguing that there should be fee caps and that hospitals should be more transparent so patients are not surprised by additional costs.
However, hospital officials have long argued that facility fees represent an important part of their revenue stream.
Jeff Austin, vice president of government affairs for the Maine Hospital Association, argued during this year’s legislative debate that a ban on facility fees “would have devastating financial impacts on hospitals, including the potential closure of some facilities and loss of patient access to health care services.”
After years of debate, studies and intense lobbying by hospitals, Maine passed a watered-down version of the facility fee rules earlier this year that only requires hospitals to disclose that they charge such fees, without disclosing the amount of the fees. Even the watered-down version of the law had not yet taken effect when Brignac left for MaineGeneral in May.
Stricter regulations, such as banning fees for telemedicine appointments or in outpatient facilities, were rejected.
According to an analysis by the PIRG Education Fund this year, fifteen states, including Maine, have laws regulating facility fees, while the majority of states either have no laws or neither prohibit nor restrict these fees.
Only seven states impose significant restrictions or bans, with Connecticut having the most stringent measures. Connecticut prohibits, among other things, the charging of facility fees for outpatient services or telemedicine appointments.
According to the PIRG analysis, there is “no rhyme or reason” to the level of facility fees. “Facility fees vary enormously and can add a few dollars to the bill or more than $1,000,” the report said.
Ann Woloson, executive director of Consumers for Affordable Health Care, a Maine patient advocacy group, said she would like to see Maine lawmakers take more steps to more tightly regulate facility fees. Brignac’s case is an example of why more needs to be done, Woloson said.
“There needs to be more transparency about how hospital fees are determined,” Woloson said. “And the fees should be appropriate for the service provided.”
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