Aperture Insurance Solutions

04/14/2026

💡 Why Did My Doctor Visit Cost That Much?! Let’s Talk About Facility Fees…

Ever gone in for a routine visit and thought,
“Wait… why is this bill so high?”

I came across this article from WPSU recentlyy and am glad that this topic is getting some traction. You’re not alone, I talk to clients daily about hidden fees showing up on their bills. The most recent cause for concern is something called a facility fee.

🏥 What is a facility fee?
It’s an extra charge added when your care is billed through a hospital-owned facility — even if it feels like a normal doctor’s office visit.

That means:
✔ Same doctor
✔ Same service
❗ VERY different bill

In many employer health plans, this can lead to:
• Higher out-of-pocket costs
• Separate charges (provider + facility)
• Faster accumulation toward your deductible

📍 Here’s where it gets tricky:
You might not even realize your doctor’s office is considered “hospital-based” — especially after mergers and acquisitions in healthcare.

💬 What can you do?
• Ask your doctor at the time of service: “Is this visit billed with a facility fee?”
• Review your EOB (Explanation of Benefits) carefully
• Work with a broker who actually explains how your plan works

This is the first of a three-part series looking into what a facility fee is, why hospital outpatient clinics charge them, and what’s being done at the state level to protect people against surprise bills from facility fees.

06/10/2025

I have been receiving a lot of questions recently surrounding this topic, and this article helps to clear some things up regarding changes to the individual marketplace.

The vast majority of Affordable Care Act (ACA) Marketplace enrollees receive a tax credit that lowers enrollees’ monthly payment for health insurance. Established as part of the ACA, premium tax credits were originally available for enrollees making between 100%-400% of poverty. More recently, the...

03/05/2025

We find that spring is often the time of year when individuals begin getting caught up on preventive services such as annual physicals, lab work, and more. Here are a few tips to consider when going through this process:

1.) What is the Preventive Schedule of Benefits?
Answer: The Preventive Schedule of Benefits is a list of services that must be covered by ACA-compliant health plans. This is governed by the United States Preventive Services Task Force. Each health insurance carrier will have its own format for the schedule, but it should generally cover the same services.

2.) What is covered under the Preventive Schedule of Benefits?
Answer: The list is vast, but the most common services include age-appropriate colonoscopies, age-appropriate mammograms, lipid profile (lab work), and immunizations. You should refer to your insurance plan's Preventive Schedule for specifics.

3.) Things to be aware of:
Tip: "Preventive" care is one of the biggest causes of frustration for health plan members. Doctors will often say that they would like to run some "preventive lab work." While this lab work may be "preventive" in nature to the doctor, it often falls outside of the standard lipid profile included in the Preventive Schedule of Benefits. As a result, it may not be fully covered, and you could receive an unexpected bill. This tip is not meant to suggest that you should only have work done that is listed on the preventive schedule, but it is meant to help you understand why you might receive an unexpected bill.

4.) Tips to lower your cost of lab work:
Tip: Instead of using a hospital-owned lab for your lab work, consider checking out outpatient lab facilities such as Quest Diagnostics or LabCorp. These outpatient lab centers have lower overhead than hospitals, so they often charge significantly less for the same lab work. This is especially important if the cost of lab work applies toward your deductible rather than a flat copay. Just make sure that the outpatient lab you choose is in-network with your insurance policy before proceeding.

If you have questions about your bills, you should not be afraid to reach out to your health insurance broker or insurance carrier to ask why you received the bill. It is often an easy explanation, but it's always better to be sure the billing is correct before making a payment.

02/26/2025

👋 Welcome to Aperture Insurance Solutions!

We’re excited to connect with you! As a trusted independent insurance agency and employee benefits consulting firm, we specialize in helping you find the best coverage for your needs. Whether you’re shopping for yourself, your family, or your business, we’re here to simplify the process and ensure you get the plans that provide the most value to you.

Stay tuned for helpful tips, news, and updates to help you make informed decisions about your health coverage.