The bright owl patterns on Michele Vincent’s scrubs were a stark contrast to the grey walls in the dental clinic where she works as an assistant. As Vincent set up medical instruments for the doctor to use, she talked about the toll her work has taken on her hands for more than 34 years.
“My right hand, the middle finger there, if I close my hand, it tends to actually get stuck,” she said. “There’s pain by the end of the day.”
That led her to see a specialist at a hospital in New Britain in December 2024. The solution he offered was simple enough. He gave her a cortisone shot and Vincent said it worked to reduce pain and swelling.
Then the bill came. Vincent was charged $225 for the doctor’s services, which she expected.
But on top of that, there was an out-of-pocket charge for $924 tacked on to the bill. It was a facility fee — a separate amount that covers the hospital’s operational expenses, such as building maintenance and equipment.
Across the country, facility fees like the one Vincent received are increasingly common because of consolidation in health care. Hospitals and health systems own many of the clinics where patients are treated. They collect fees to pay for providing care around the clock — even for routine outpatient treatment.
Vincent said she felt blindsided.
“No one explained that to me,” she said, recounting how short her visit was. “I literally walked from the garage, right behind the entry desk, and that’s where the office was.”
The doctor was in and out of the consulting room in about ten minutes. Vincent said she left right after.
She called the billing department thinking it was an error. It was not, and she got on a payment plan.
In Connecticut, hospitals can charge facility fees for both inpatient and some types of outpatient services. They're permitted when a facility is owned by or affiliated with a hospital or health system.
The state has some of the tightest restrictions on these fees. Even so, state records show revenue from facility fees has grown in recent years, topping $2 billion in 2024 alone.
Advocates for health care reform have sharply critiqued facility charges, which they say cause confusion for patients, forcing some to take on medical debt for surprise expenses.
“People shouldn't be charged facility fees when they're not even entering the hospital,” said Colin Reusch, director of policy at Community Catalyst, a nonprofit that advocates for health justice.
Reusch said the fees can be excessive, and have increasingly been a tool for private equity firms to extract profits from hospital acquisitions.
“Those firms are looking to turn around as much profit as possible in the shortest amount of time," Reusch said, "and facility fees, unfortunately for patients, are a quick and easy way to tack on additional charges."
Fees pay for essential care
Connecticut lawmakers have tried to curtail fees for routine medical visits. Focus has been on outpatient services to evaluate, assess or manage a patient’s health.
But Paul Kidwell of the Connecticut Hospital Association said hospitals need facility fees to keep functioning.
“We are supporting infrastructure that maintains an emergency department that is open 24 hours a day, seven days a week,” he said. “In our view, there are certainly very legitimate reasons for why we need those fees to maintain the facility that allows for the services.”
Kidwell noted that Connecticut law requires patients to be notified in advance when facility fees are added to their bills. Hospitals also post signs.
Hartford HealthCare operates the New Britain hospital where Vincent got her cortisone shot. A spokesperson said facility fees are necessary to support essential expenses.
"Facility fees may be associated with hospital-based outpatient locations, depending on the services provided at that location pursuant to state and federal law, and help support the staff, technology, safety standards, infrastructure, and care coordination needed to operate the hospital and provide the highest quality, integrated care," the spokesperson said.
Among doctors, views are mixed on the necessity of the fees.
Dr. Dinesh Kapur runs one of the few independent oncology practices in the state. The office also offers a research department and labs. No patient is turned away because they don't have insurance coverage, Kapur said.
Medical offices like his charge a single fee with no separate facility charge. Kapur said the total amount is typically much lower than receiving care in a facility controlled by a hospital.
Walking into the area where patients were receiving infusions, Kapur said the people he treats typically pay about half of what hospitals charge.
Kapur placed the blame for rising facility fees on hospital consolidation. As hospital systems buy up more independent practices, patients will see these fees added to their bills, he said.
"By taking over these medical practices and rolling them into their medical groups, they are now able to have the medical groups start sending patients to the hospital facilities," he said. "And by doing so, they're raising [the] cost of care.”
Reining in hospital fees
Connecticut has complex restrictions on facility charges. They distinguish between care provided on or off the campus of a hospital — defined by whether the site of care is within 250 yards of one.
Hospitals have been prohibited from charging facility fees for certain routine services at off-campus locations since 2017. However, it's unclear whether the change was successful in lowering health care costs, as lawmakers intended.
In a study published in December 2025 in the journal Health Affairs Scholar, researchers found Connecticut's prohibitions on outpatient fees had little impact on the operating margins of hospitals. The authors of the study speculated that hospitals may have adapted by changing their billing practices or negotiating payment arrangements to make up for lost revenue.
“While the law changed what hospitals could bill, it did not change their relative bargaining power,” the authors wrote. "Nothing in the law limited the ability of Connecticut hospitals from increasing their charges for and revenue from other items and services, or through other forms of payment.”
The state extended similar restrictions to on-campus locations in July 2024. However, exceptions still exist for emergency departments and certain on-campus visits.
Connecticut hospitals report data on facility fee revenue each year to the state Office of Health Strategy (OHS). OHS can issue penalties, but has yet to find any violations, according to the agency.
Olga Armah, OHS manager of data and research, said the information the state collects has limitations. It isn't detailed enough to determine whether certain charges are prohibited; if anything looks off, analysts have to ask the hospital for more information.
But even that process is not conclusive. Armah said state officials don't have access to the contracts that govern billing at each hospital, which are necessary to determine whether new restrictions have taken effect.
Another avenue for OHS to investigate a charge is when a patient files a complaint alleging a potential violation.
But few complaints are received each year. Records provided in response to a Freedom of Information Act request show OHS has documented only a handful in the recent past. Armah said most patients are probably unaware the option exists.
One complaint submitted last year described a visit to an urgent care facility that was billed as an emergency department encounter.
The patient received routine treatment for a headache, and was later charged a $300 facility fee.
The patient said billing staff confirmed the visit would be treated as emergency care, even though it occurred inside an urgent care facility.
Two other complaints involved fees charged for routine visits to off-campus locations.
An OHS representative said in an email that the office investigated each complaint and did not find any violations.
OHS is set to be dissolved in June as part of a reorganization enacted by state lawmakers. The Connecticut Department of Public Health will take over responsibility for overseeing facility fees.
All this is not much consolation to Vincent, the dental assistant. Her cortisone shot from 2024 has worn off and she’s in pain. But she’s choosing to not get treated.
“I am afraid that I'm going to be charged for that," she said. "Another hospital fee.”
