Have you been billed for two copays related to a single outpatient medical appointment? MOAA’s investigating similar reports, and your experience may help clear up a question of TRICARE policy. 

Some TRICARE beneficiaries have been billed a copay for a facility fee in addition to the typical copay for their provider office visit, MOAA has learned recently. We are working to clarify how facility fees are handled by TRICARE, but in the meantime, we would like to get a better understanding of the scope of this issue.  

If you believe you may have been charged a second copay for an office visit, related to a facility fee, please tell us at legis@moaa.org. 

Facility fees aren’t new. Hospitals are allowed to charge patients a facility fee, on top of the charges for medical services, to help cover the high cost of running a hospital. Patients sometimes encounter facility fees when they receive care from a provider office attached to a hospital or medical center.  

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As hospitals buy up physician practices, urgent care centers, walk-in clinics, and standalone surgery centers, patients are more likely to encounter a facility fee even when they receive care outside the hospital setting. About 31% of all physician practices were owned by hospitals in 2018, up from 14% in 2012, according to a study by the Physicians Advocacy Institute.  

Since the new TRICARE copay construct was implemented in January 2018, it has been MOAA’s understanding that TRICARE beneficiaries would not be charged a separate copay for facility fees. We have asked TRICARE officials to clarify the policy and, if it appears TRICARE beneficiaries have been charged facility fee copays in error, we will follow up ensure the problem is fixed both retroactively and moving forward.