Adrienne R: How a Surprise Facility Fee Left Her Fighting the System

Adrienne, a Pennsylvania resident and mother of two, never expected a simple diagnostic procedure to lead to over a year of financial and emotional distress. In February 2024, she underwent a thyroid biopsy at a hospital she knew well, the hospital where she gave birth to both of her children and one she visits frequently for appointments. Everything about the process felt routine—until the bill arrived.

Weeks later, Adrienne received three separate bills for this procedure. Two were covered by her insurance. But the third, a $5,000 facility fee bill, was not.

“I don’t really have $5,000 sitting around that I can just throw at a medical facility fee,” she said.

Like many patients, Adrienne had signed a standard waiver before the procedure, agreeing to pay the charges even if out of network. But at no point was she told the facility would be considered out of network under her insurance plan (spoiler alert: it wasn’t.)

Adrienne began making calls to the hospital’s billing department and her insurance company trying to get answers. “I probably spoke with a dozen people,” she said. “And every time, I guess I failed to use the proper magic word, which is a formal appeal.”

Once she was able to file a formal appeal, it was denied.

After exhausting appeals with both the hospital and her insurer, Adrienne turned to the Pennsylvania Attorney General’s office, which has a health care division. “I do encourage anybody to use that resource if they feel so inclined,” she says. “Maybe a hospital system doesn’t care what I have to say, but maybe they’re going to respond a little bit differently to the Pennsylvania attorneys general.”

The AG’s office managed to a response. A compliance officer from the hospital confirmed in writing that the charge in question had, in fact, been for an in-network procedure, contradicting what Adrienne had been told by multiple billing representatives. “We now know that it was in fact in-network, but we received that documentation in 2024 and it’s 2025 and I still don’t have that money back.”

For Adrienne, the issue is about more than just a billing dispute. “It’s not like I went in for elective surgery,” she says. “This was a miserable experience where I went to the doctor because I didn’t know if I had cancer.”

While thankfully, the biopsy results came back clear, the experience has shaken her confidence in seeking care altogether.

“I know I’m supposed to get biopsies every year to see whether or not the masses in my thyroid are malignant. And I haven’t gone back. Would you?”

Now she’s facing the possibility of surgery to remove the masses entirely. But instead of preparing for the procedure, she’s filled with fear—not just of the diagnosis, but of the bill.

“I have two very young children, and if I am not seeking medical treatment, that can impact my family.”

Frustrated not just by her own experience, but by the larger system that made it possible, Adrienne adds, “you’re not going to the hospital because you’re in good health. You’re going because you need help. And that’s when they choose to take advantage of people when they’re most vulnerable.”

She considers herself relatively fortunate to be able to advocate for herself, knowing that many others wouldn’t have had the time or resources to fight back, especially against a system that is not built to give patients the advantage.

Even with the hospital’s written confirmation that the charge was in-network, she still hasn’t been refunded. “We’re doing the best that we can,” she says. “I finally did get up the courage to go see a doctor again.”