END HIDDEN FEES AND PROMOTE TRANSPARENCY
Iowans are Paying Hundreds More in Hidden Fees — Here’s Why
Across Iowa, patients are opening their medical bills to find unexpected charges, often totaling hundreds of dollars for facility fees and services that used to cost nothing or far less.
Part of the reason for this is a growing trend of hospital system mergers with smaller, independent clinics, often acquired by out-of-state private equity firms. These transactions are quietly changing the way care is billed and increasing costs for hard-working Iowans.
In many cases, when a hospital system acquires a local clinic, the site is reclassified as a “hospital outpatient department.” That change allows the hospital to bill patients not just for the doctor’s services, but also for a “facility fee,” an added charge that can run from $100 to over $500, even if no hospital was involved in the visit. (Iowa Capital Dispatch).
FOR EXAMPLE:
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After Mission Cancer and Blood was acquired by the University of Iowa Hospital, paying a staggering $280 million dollars, a long-time patient saw her bill jump from a $20 copay to $807 overnight — for the same routine treatment she’d received for years. The only difference: it was now considered hospital-based care. (MSN)
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In Southeast Iowa, patients at several clinics now receive two bills for one appointment: one for the doctor’s time, and another for facility use — even if the visit didn’t take place in a hospital building.
Worse, a 2024 audit found that 60% of Iowa hospitals are not following federal price transparency rules, making it difficult for patients to compare costs or catch billing errors. (Iowa Public Radio)
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This matters deeply because many Iowans are already struggling financially: 36% of Central Iowa residents say they couldn’t cover a $400 emergency expense without borrowing money or going into debt. (Axios Des Moines).
Some states have already taken action:
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Indiana passed a law that requires the Attorney General to review any healthcare merger over $10 million, allowing for antitrust review and disclosure of ownership, including private equity interests.
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States like Connecticut, Colorado, and New York have passed laws to ban facility fees for certain services, including telehealth and non-hospital care.
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At least 15 states now have bipartisan laws in place that require disclosure or limits on facility fees.
These efforts reflect a growing consensus: hidden fees, opaque billing, and unchecked consolidation are driving healthcare costs higher, and patients deserve protection.