A 5-Minute Video Call. A $200 “Facility Fee.” What?
You skipped the waiting room. You saw a doctor from your couch. You thought you were being smart about healthcare costs.
Then the bill arrived. Right there, below the $75 consultation fee: “Facility Fee — $200.”
You weren’t in a facility. You were in your living room. So why are you paying for one?
This is one of the most confusing charges in American healthcare right now — and it catches thousands of telehealth patients off guard every year. Here’s exactly what it is, when it’s legitimate, and what you can do about it.
What Is a Facility Fee, Exactly?
A Facility Fee is a charge hospitals and hospital-owned clinics add on top of your doctor’s fee — just for using their physical space, equipment, and staff.
Normally, that makes some sense. Running an ER or a surgery center is expensive. But here’s where it gets frustrating:
If your telehealth doctor works for a hospital-owned practice, the hospital can charge you a Facility Fee — even when you never set foot in their building.
⚠️ The Two Types of Telehealth Doctors
Hospital-employed doctor: Works for a hospital system (like Kaiser, Cleveland Clinic, or a major health network). When you see them — even virtually — the hospital bills a Facility Fee on top of the doctor’s fee.
Independent telehealth doctor: Works for a standalone telehealth platform (like Teladoc or MDLive). No hospital affiliation = no Facility Fee. You pay one flat rate.
Most patients have no idea which type they’re seeing until the bill arrives.
Is This Charge Legal?
Unfortunately, yes — in most cases.
The No Surprises Act (2022) protects you from surprise out-of-network bills, but it does not ban Facility Fees. As long as the hospital discloses the fee — even in fine print — they’re technically allowed to charge it.
That said, you still have options.
When You Can Push Back
✅ Grounds to Dispute a Telehealth Facility Fee
🔍 No prior disclosure: If you were never told about the Facility Fee before your appointment, you have grounds to dispute it. Hospitals are required to disclose fees upfront.
📋 No Good Faith Estimate: Under the No Surprises Act, uninsured or self-pay patients must receive a written cost estimate before care. If you didn’t get one, and the bill is $400+ more than expected, you can formally dispute it.
❌ Wrong billing code: Sometimes Facility Fees are billed under an incorrect code. Request an itemized bill and check if the code matches a telehealth visit — not an in-person one.
🏥 Non-hospital platform: If you used an independent telehealth app (not a hospital portal), a Facility Fee should not appear at all. That’s a billing error.
The Phone Script: What to Say
Call the billing department and use this script word for word.
📞 Script: Disputing a Telehealth Facility Fee
You: “Hi, I’m calling about a Facility Fee on my account number [XXXX]. My visit was conducted entirely via telehealth — I was not present at any physical facility.”
You: “I was not informed of this fee prior to my appointment. I’d like to request a formal review of this charge and ask that it be waived or reduced.”
If they push back: “Can you send me the written disclosure of this fee that I would have received before my visit? I’d like to review it before making any payment.”
Tip: Write down the name of the person you spoke to and the date. Ask for a reference number for the call.
If They Won’t Budge
Don’t give up after one call. Here’s your escalation path:
1. Ask for a supervisor. Front-line billing staff often can’t waive fees on their own. A supervisor sometimes can.
2. Ask about financial hardship programs. Many hospital systems will reduce or waive Facility Fees for patients who qualify for charity care — regardless of whether the visit was in-person or virtual.
3. File a complaint with CMS. If you believe the fee violates disclosure requirements, call the No Surprises Help Desk: 1-800-985-3059.
Navigator Alex Tip
Before your next telehealth appointment, ask this one question: “Is this doctor employed by a hospital or health system?”
If the answer is yes — or if you’re booking through a hospital’s own app or portal — assume a Facility Fee is coming. Ask for the full cost breakdown in writing before the visit. That one question can save you hundreds of dollars.
And if you want to avoid Facility Fees entirely next time, independent telehealth platforms are the way to go. I’ll cover exactly how to choose the right one in the next guide.
📋 Related Guides — Fight This Bill
More tools to dispute unexpected charges and protect your wallet.
🧾 How to Request an Itemized Bill — Get every charge in writing before you pay anything.
⚖️ What is the No Surprises Act? — Know exactly what federal law covers — and what it doesn’t.
📞 Script for Disputing a Medical Bill on the Phone — A full word-for-word guide for any billing dispute call.
🚨 Common Hospital Billing Errors — Facility Fees are sometimes coded incorrectly. Here’s how to catch it.
🏥 Hospital Charity Care Income Limits 2026 — Can’t afford the fee? You may qualify for a waiver.
Disclaimer: This article is for educational purposes only and does not constitute legal or financial advice. Facility Fee rules vary by state and provider. Always request written cost estimates before your appointment and consult a patient advocate or attorney if you believe a charge is unlawful.