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X-files theory: mulder & scully's field trip never ended.

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Mulder and Scully may never have actually escaped their predicament in The X-Files episode "Field Trip." Over their decade-plus run on The X-Files , Mulder and Scully found themselves entangled in many life or death situations, and also famously encountered lots of monsters and creatures that don't actually exist. The fungal threat found in "Field Trip" — which aired between the times the FBI shut down the X-Files department  — is something altogether unlike anything the agents have encountered before.

The  X-Files  monster-of-the-week fungus was massive, spreading for miles underground, and was able to release spores that caused its victims to enter a hallucinogenic state. Once in that state, the malevolent organism trapped its prey underground and placed them in a kind of narcosis, slowly digesting them. The creature's hallucination states were very intricate, and could seemingly make the victim perceive anything the creature deemed necessary to placate them into staying asleep. How exactly it's able to tailor these hallucinations to specific victims, or exactly how intelligent the giant fungus was, goes unanswered by the episode's end — but it's hardly the weirdest X-Files monster, not with "death fetishist" Donnie Pfaster in the mix.

Related: X-Files Theory: Cigarette-Smoking Man Has John Doggett Captive

Of course, Mulder and Scully, prove to be the ones finally capable of breaking the "Field Trip" creature's spell and living to fight another day. At least that's what appears to happen at the end of the episode. When examined more closely though, there's reason to believe that the pair of X-Files agents never actually made it out of the creature's lair.

What Happened to Mulder & Scully in Field Trip

"Field Trip" begins with a rather ghastly setup. Two hikers head home after what seems like a fun day outdoors, but signs appear that something is off. The couple lies down together in bed, only for the scene to then cut to their skeletons lying together in a similar fashion. It's arguably one of The X-Files ' darkest moments apart from the infamous episode "Home,"  and sets the stage for what's to come when Mulder and Scully are sent to investigate what caused the two mysterious deaths. As often happens, Mulder and Scully split up, which turns out to be a mistake, as Mulder is exposed to the hallucinogenic spores released by the underground creature. Scully later goes to find to Mulder, only to also be exposed.

While it's not made entirely clear why they end up sharing the same hallucination — although the couple in the beginning also appeared to be sharing one — Mulder and Scully eventually come to realize what actually happened, and that they're being slowly digested underground by the enormous fungus monster. This revelation seemingly causes them to wake up, then escape, and later be seen filing their report to FBI boss Walter Skinner . An increasingly suspicious Mulder insists that he and Scully never escaped, and that they're still trapped underground, shooting "Skinner" to prove it. He turns out to be right, leading Mulder and Scully to escape for real, being rescued by Skinner and an FBI team, all wearing masks to protect against the spores. Everything seems all right on the surface, and The X-Files moves on as a show from there. Yet, there's good reason to believe their second escape was just as false as their first.

Field Trip's Monster Can Manipulate the Perception of Time

In some ways, the plant-like creature in "Field Trip" may be the most powerful "monster of the week" X-Files heroes Mulder and Scully ever encountered. As seen by its multiple attempts to keep Mulder and Scully under its spell, the creature is highly intelligent, capable of designing and redesigning its hallucinations specifically to fit what it thinks will fool them into a docile state. While it's never clear exactly how much time Mulder and Scully believe to have passed for them inside one of these hallucinations, it seems to at least be multiple days, if not weeks. Thus, the creature can make its prey perceive the passage of a much longer period than has actually occurred. Beyond just the time manipulation aspect, there are some decidedly sinister hints that the ending of "Field Trip" in which Mulder and Scully successfully escape isn't real.

Related: How The X-Files Cost Gillian Anderson A Role In The Hannibal Movie

First off, when making his case to Scully that they're still underground, Mulder points out that no known hallucinogen wears off if the person hallucinating realizes they're hallucinating. Yet, that's exactly what happens when Mulder and Scully wake up the second time, and are seemingly saved. During the same speech, Mulder also points out that they were covered by digestive acids, yet have no marks on their skin. The marks are then there during their "real" escape, but could be a case of the plant creature learning from its prior mistake when crafting this new hallucination. Most oddly of all, their rescue from the ground by the FBI just feels off. They aren't treated at all at the scene, but instead shoved straight into an ambulance. Even weirder, the ambulance appears to have absolutely nothing else inside of it, and no paramedics are there to attend to Mulder and Scully. Real ambulances are full of medical equipment, since someone in need of an ambulance may well require treatment on the way to the hospital. The entire final scene rings false.

Mulder & Scully Never Escaping Field Trip Explains Later Seasons

While the idea that Mulder and Scully didn't make it out of "Field Trip" alive is certainly a sad one in-universe, back in reality, it could serve as a handy way to hand-wave just how bad The X-Files got in its later years. Sure, every season, barring the almost universally awful season 9, had a few episodes good enough to deserve the X-Files name — especially the ones written by Darin Morgan  — but most fans would agree that season 7 onward saw a large dip in quality. Additionally, there are many who wish the highly flawed X-Files revival had never even been made, as they believe it served to tarnish the show's image.

If nothing Mulder and Scully experienced on The X-Files after "Field Trip" was real, that could explain the many nonsensical plot twists and out-of-character actions seen in the ensuing seasons. The plant creature is likely piecing together these hallucinations from what it can draw out of the minds of its prey, but what it receives is probably a bit of a jumble of thousands of memories, leading to imperfect recreations that fail to follow a logical dramatic progression. This would explain things like killing off The Lone Gunmen for no real reason other than shock value. It's possible though that the deeper Mulder and Scully were sucked into this hallucinatory rabbit hole, the harder it became for them to notice these inconsistencies. Basically, Mulder and Scully may have died slow deaths, but at least they likely didn't know it was happening and didn't have to live long enough to actually get into fistfights with their own doppelgangers.

More: Why The X-Files Season 12 Never Happened

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The X-Files S06 E21 "Field Trip" » Recap

"They're affecting your head... maybe mine, too. What if I can't even tell what's real?" — Wallace Schiff

• A Glitch in the Matrix : Both Mulder and Scully realize at various points that things are not what they seem and that they are in a hallucination.
• Double-Meaning Title : "Trip" as in "expedition" and as in "hallucinatory experience".
• Dream Within a Dream : Mulder and Scully realize the mushroom is causing them to hallucinate and snap out of it... except, not really.
• Fungus Humongous : The episode features a giant underground fungal complex; the non-sentient growth sucks down its human victims and doses them with powerful hallucinogens to keep them docile while it slowly digests them.
• Mind Screw : Bizarre things happen inside Mulder's and Scully's hallucinations, such as the Lone Gunmen believing Scully's case report, as well as Mulder retrieving an alien from the cave.
• Monster of the Week : A very dangerous fungal complex.
• Mushroom Samba : The spores Mulder and Scully are exposed to for most of the episode are said to have similar effects to LSD.
• Schrödinger's Butterfly : There's no way to be sure that the final scene in which they were rescued is real. It's possible that it wasn't, but they were still ultimately rescued, as people knew where they were going, and their vehicles were parked in the open not far away. It's also possible that they were never rescued and the entire rest of the series is their extended hallucination as they lie dying underground .
• Together in Death : In the teaser, a couple is shown cuddling and lying together in bed facing each other. The final shot of the teaser reveals they are already skeletons.

Wait a second... WHAT WOULD POSSESS US TO EVEN SAY SOMETHING LIKE THIS?! TV TROPES WILL CONTINUE EATING AWAY AT OUR LIVES FOREVER! ...Come to think of it, is something else eating away at us now?!

• The X-Files S06 E20 "Three of a Kind"
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The X-Files Archive - Sixth Season - Field Trip

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Field Trip (1999)

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Dana Scully

Guest Stars 7

Walter Skinner

Wallace Schiff

Angela Schiff

John Fitzgerald Byers

Richard 'Ringo' Langly

Melvin Frohike

Kim Manners

Frank Spotnitz

John Shiban

Vince Gilligan

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The X-Files : “Field Trip” / Millennium : “Via Dolorosa”

“Field Trip” (season 6, episode 21; originally aired 5/9/1999)

In which all is a dream

Is there any twist more unsatisfying than “It was all a dream”? Maybe that’s a twist that can work once or twice when you’re a little kid—I remember being blown away by it when I was 4 or so—but once you get past those first couple of uses, it starts to feel like a cheat. If the storyteller isn’t going to take his story seriously, then why should you? If the rug can be pulled out from under you at any time, then there’s no good reason to trust the storyteller, and trust is something implicit to the act of listening to a story. M. Night Shyamalan rather exemplifies this rule, to the point where his twist endings ultimately made him seem somehow lesser in a lot of viewers’ eyes. He had pulled the rug out a few too many times, and we’d gotten tired of that.

“Field Trip” is one of my favorite episodes of The X-Files ’ sixth season, but it’s an episode that sets such an impossibly high bar for itself that it’s one I’m surprised the show was able to cross. Much of the sixth season has been about the relationship between what’s real and what’s just in our heads, and this is the ultimate examination of that, as our two protagonists are trapped inside of an active hallucination, one that’s working as hard as it can to keep them from moving, that they might be digested by a giant fungus. On one level, it’s a bit of a mind-fuck episode—the twist at the very end when Mulder realizes that, no, he and Scully haven’t escaped the fungus is beautifully executed. But if it was just that twisty, complicated bit of business, it wouldn’t have the resonance it does. No, what makes “Field Trip” work is that it’s as much an examination of the Mulder and Scully relationship—and the way they complete each other in a nearly mystical way—as last season’s “Bad Blood.” This is an episode explicitly about the show and its central characters, and that gives it its beauty.

The best choice the script—by Vince Gilligan and John Shiban, from a story by Frank Spotnitz—makes is to isolate Mulder and Scully, then bring them together. In some ways, “Field Trip” is all about asking just what Mulder and Scully would most want, then giving it to them. This seems fairly easy in the case of Mulder: He wants proof that the aliens are real. It’s more difficult in the case of Scully, but the episode zeroes in on something really sort of tragic about her: She just wants to be right. This whole time she’s been on the X-Files, Mulder’s crazy-ass theories have almost always proved to be the case, while she’s been forced to ride along and realize the world is weirder than she gave it credit for. Scully is a character who’s not just trapped by her own rational brain or by having to watch her partner’s theories proved correct. She’s a character who’s trapped by her own show . She’s forced to play a certain part by the series she stars in, and when the hallucination is giving her what she wants, it doesn’t just involve people buying one of her theories; it involves Mulder’s death.

This is a marvelously complicated bit of business. By this point, we’ve essentially figured out that some strange goopy thing is making Mulder and Scully see things that aren’t there, just like the young couple in the opening scene (played by David Denman and Robyn Lively!). The fact that Mulder’s skeletonized remains turn up just clinches this fact: The show isn’t going to kill off its male lead so unceremoniously. But this is what’s smart about “Field Trip,” I think. It gets the “it was all a dream” propers out of the way very early on, that we might get down to the more knotty business of how dreams can reflect our worst fears and greatest hopes. For anybody to take Scully seriously, Mulder has to die, because he’s always been what’s standing in the way of her theories. Yet his death, understandably, all but guts her, and the way that the coroner, then Skinner, then the Lone Gunmen parrot her theory about ritualistic murder right back to her becomes terrifying in its own right.

What’s easy to miss is that roughly the same thing happens in Mulder’s hallucination, when he brings Scully over to his place to meet the presumed dead couple and the little Gray that he abducted and kept in the spare room. (The Gray, for its part, seems totally fine with this.) These hallucinations reveal, on some level, that both Mulder and Scully crave being proved right . But where Scully’s hallucination reveals that to be proved right would involve such a change to her status quo that she doesn’t want to contemplate it, Mulder’s hallucination reveals that, on some level, he needs the pushback, needs people to think he’s crazy. When Scully says that, yeah, he’s sure proved the existence of aliens all right (since, let’s not forget, he has an alien in his apartment ), he seems a little hurt. He enjoys always being right, sure, but he almost seems offended at the idea that Scully would give up in the fight, would just cede this argument to him. He needs the pushback, but so does the show.

Even as the show is about the weird dichotomy of this partnership, the way that Mulder and Scully fill in the gaps in each other, “Field Trip” is also about a series approaching the end of its sixth season and looking for new stories to tell. Season six was filled with these sorts of hallucinations and dream sequences, and I suspect that’s because this far into the show’s run, there was simply no way to keep playing out the string of these weird mysteries without understanding, on some level, that it was all bullshit. There’s no way that Scully would keep questioning Mulder this long once she realized he was always right. There’s no way Mulder would always be right. These things only happen because the story of the show requires them to. In a lot of ways, season six is an artful dodge of many of these questions. Through comedy and mind-fucks and structural experimentation, The X-Files spent so much of its sixth season both questioning why it was still going and why we kept watching it, and “Field Trip” is sort of the ultimate expression of both of those questions.

Yet “Field Trip” answers those questions perfectly with that last shot. Mulder and Scully, pulled from the ground before getting eaten by the fungus, lay in the back of the ambulance, exhausted, but alive. It’s like a tacit acknowledgement by the show that these people shouldn’t keep getting so lucky, yet they do. (In particular, Skinner and the coroner’s arrival to save them feels almost as if Mulder and Scully, in the midst of their shared hallucination, have willed their rescue into existence.) He reaches out for her hand, and she finds it, and in that connection, the increasingly shaky show is supported. The hallucination hypothesis is one Scully arrives at, but it’s one Mulder bolsters. These mysteries can only be solved if both of these people are working to solve them. In its sixth season, The X-Files wandered away from its own increasingly constrictive formula as much as it could, heading out into the hinterlands in search of new pulp myths to exploit. The thrill of “Field Trip” is that there are still blank spots to write “Here Be Monsters,” as surely as there are still these two people to head into caves and fight them together.

Stray observations:

• Hey, it’s Jim Beaver as the coroner! At first, I didn’t remember how important he was to the episode, but he does a fine job of playing essentially two versions of the same guy, one filtered through Scully’s subconscious.
• The visual effects in this one have not aged well, have they?
• Mulder pulling the gun on Skinner and shooting him three times in the chest is one of the great, thrilling moments in the show. Dream sequences are often a way to do these sorts of “We would never do this!” moments, and the writers clearly relish the chance to use them thusly here.
• The script is very canny in the way that it pulls in the Brown Mountain Lights to give this an added sense that, hey, maybe it is aliens.
• Robyn Lively may be most famous for her work on Twin Peaks and being related to Blake Lively, but I will always remember her as the Fairy in Return To Zork . (You may call me a nerd in comments.)

“Via Dolarosa” (season 3, episode 21; originally aired 5/14/1999)

In which the season is ending soon, so we’d better wrap this up, huh?

I literally don’t know what to say about “Via Dolarosa.” I don’t even mean that in the “I’m just saying this so I get to bullshit for a paragraph or two before writing 5,000 words about it” way either. I mean it in the, “This episode is the first part of a two-parter, and is so evidently constructed to be so that it’s hard to say much about it without talking about the ultimate series finale as well” way. At least the second season finale’s first half featured some bravura sequences that let you know this show wasn’t kidding around with the end of the world business. “Via Dolarosa” is just a weak effort to continue to tie the show’s serial killer roots together with its biblical ambitions, one that the show kept trying to pull off in its third season and one that it never really figured out.

At its center, “Via Dolarosa” is just another serial killer tale, only its one the episode keeps trying to insist is important, despite all evidence to the contrary. As the episode begins, Frank goes to Jordan’s school to pull her from class and take off, racing with her down the hallway. This, presumably, will be paid off in the next episode, since it’s sure not paid off here. (As an attempt to get us excited for next week, it’s a little weak, also, since I basically forgot it happened until I read a summary of the episode.) From there, we go to Frank sitting in the audience for an execution. As the criminal is brought to the electric chair, he mouths “Yes” to someone in the audience, and, of course, that someone in the audience is going to head out into the world and start replicating the dead man’s crimes, complete with a little overlay of religious symbolism for kicks.

This really speaks to how Millennium has had trouble building an overarching mythology. It did all right with some aspects—particularly the Millennium Group—in its earlier seasons, but it’s really become a mess in season three. If the serial killer that Frank sits in on the execution of had been built up as a figure of importance before these episodes, they might have had the sort of weight the series wants them to have. Instead, it’s hard to get too worked up about this particular copycat serial killer being strong enough to carry a two-part season finale, because everything he does is something that’s new to us. He’s copycatting someone, but we really just have to take Frank’s word for it, since we don’t know a damn thing about the man he’s copying.

It’d be one thing if the murder sequences were scary or something, but even those feel rather paint-by-numbers, particularly for this show. Once again, the series is mixing up sex with death, as our copycat criminal is killing rich people who are in the midst of coitus, and it’s to the point where this sort of trick just feels tired. It’s telling, I think, that the one sequence that really works here is the one where the couple notices the guy standing in their bedroom with the night-vision goggles on. In that moment, there’s some of the excitement and momentum of the better murder sequences on this show. As the killer races from the house, the home owner on his tail, the episode feels, finally, like it’s heading somewhere. Instead, it mostly doesn’t.

The other major thrust of the episode involves Emma’s dad, a storyline that the show has kept hitting and hitting, even though there’s no reason for the audience to be invested in it, beyond the fact that Alzheimer’s is sad business. Emma keeps getting distracted from her work by her dad—and the moments when he pulls a gun on her and when her pager goes off while the FBI is closing in on a suspect’s apartment are hilarious—and then Watts comes along with an offer: Get Frank fired from the FBI, and we’ll cure your dad’s Alzheimer’s. Which, what? How on Earth is Emma going to be able to get Frank fired? And how can the Millennium Group have a cure for Alzheimer’s? I know the show wants to make the Group this all-powerful secret society, but it also seems dedicated to backing away from that choice at any given moment, the better to make this a series about the grim reality of tracking serial killers.

There’s also plenty of biblical nonsense—the killer is reenacting the stations of the cross!—and an overriding preoccupation with the end of the world that feels like the show simply playing out the string at this point. The episode ends with the FBI closing in on the suspect’s apartment, and the second this started to build up, I knew it was going to end with the apartment being rigged to explode, because I’ve seen this story before, a million times. And, of course, the agents enter the apartment, and of course, Frank has a premonition of what will happen and calls for them to get out, and of course, the bomb goes off, and Emma (distracted by her pager) realizes that Frank has psychic powers or something. As a cliffhanger meant to get us back in time for the season finale, it leaves a lot to be desired, especially when coupled with the serial killer invading another home, night vision goggles on. Who cares?

That’s a question the show has struggled with since its earliest episodes, but in the second half of season one and all of season two, the series hit a sweet spot, where it managed to tell some strong, dark stories about the weight of living in a world filled with evil. It could be ridiculous in its over-earnestness, but at least it was trying . In its third season, however, the show never figured out what it wanted to be. It tried to return to the more simplistic crime-solving stories of season one, then tried to blend in some of the biblical stuff from season two when that didn’t quite work. Instead, the whole thing started to fall apart under its own poor construction. It was a season of TV that didn’t need to exist, and it never bothered to make a convincing case for what it was trying to do. Emma was always more a concept than a character, the strongest episodes almost entirely had to do with tying up old business, and the serial killer cases were almost all tired and boring.

It’s too bad that Millennium has to end here. A part of me wonders if everything wouldn’t have pulled itself together in season four, even as I know that likely wouldn’t have happened. There was good stuff in season three—particularly when it got a little more batshit insane and stopped trying to make so much sense—but it was also a season blended together from influences that never successfully blended together. Maybe that was the whole series in a nutshell, though. Maybe this was just a show born from a bunch of conflicting impulses—religious and otherwise—that made uneasy bedfellows. It was a problematic show, but it had its moments. I think if I ever rewatch, I’ll pretend it begins and ends with season two.

• I don’t entirely understand why the killer removes his night vision goggles when he’s racing from the home owner. Wouldn’t he have an advantage if he just kept them on?
• What’s really too bad about Millennium ’s constantly thwarted attempts to build a larger mythology was the fact that X-Files did it so readily. A show like this with the ensemble cast X-Files built up could have been really cool.
• Okay, so this is basically just three different series awkwardly sharing the same title and main character, huh? It’s really hard to look back at my favorite episodes of any season and imagine them sharing the same concept as my favorite episodes from other seasons.

Next week: Zack finds out what the aliens are up to in “Biogenesis,” then says “Goodbye To All That” where Millennium is concerned.

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Field Trip/Transcript

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Episode [ ]

Transcript [ ], scene 1 [ ], scene 2  [ ].

FBI HEADQUARTERS  WASHINGTON, DC

SCENE 3  [ ]

BOONE COUNTY MORGUE  ASHEVILLE, NORTH CAROLINA

SCENE 4 [ ]

Scene 5 [ ], scene 6 [ ], scene 7 [ ], scene 8 [ ], scene 9 [ ], scene 10 [ ].

This transcript was copied from insidethex.co.uk

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Costly Care: Hospital mergers with doctors’ offices contribute to patients footing the bill

(InvestigateTV) — For five years, Caren Blanzy regularly received treatment to relieve excruciating muscle pains in her neck.

For five years, she went to the same clinic, saw the same doctors and received the same medical treatment.

And for five years, her insurance paid 100% of the costs until February when the Mecosta, Michigan resident received a bill for more than $1,100, charged as a hospital facility fee.

The clinic she had been visiting became part of a large health system in Michigan, which began charging patients such as Blanzy for seeing doctors at its outpatient facilities.

It’s a growing issue that is saddling patients with unforeseen medical debt.

“For them to change the way they bill it and say it’s a hospital service, as an outpatient, it just didn’t make sense to me,” Blanzy said.

InvestigateTV partners KFF Health News reported that the share of physicians working for a hospital or in a practice owned at least partially by a hospital or healthcare out-of-pocket-limit system increased from 29% in 2012 to 41% in 2022.

The Center for Medicare or Medicaid Service, also known as CMS, stated that when facility fees are covered by an individual’s plan or coverage in connection with essential health benefits provided in-network, cost sharing of those fees is subject to the maximum out-of-pocket limit. However, when not covered by a person’s plan, those fees expose patients to financial risk. It is also likely to come as a surprise to an individual.

Blanzy has cervical dystonia, a neurological movement disorder that contracts your muscles. When she spoke with our national investigative team, Blanzy had to hold her neck in order to keep her head still.

“My head is in constant motion, my shoulder. Going through the pain and the constant motion,” Blanzy said. “It’s what they call a sensory trick. So, my brain is constantly telling the muscles to contract and move. And this helps keep, helps minimize it actually and it helps keep my head straighter.”

She needs regular treatment but now worries about how she can afford it.

I’m pretty good at looking over my statements. I was completely shocked and thought, “There’s got to be some mistake,’” Blanzy said when she saw the $1,100 charge.

“They said it was just some changes they had made. My insurance company said the same and said that it was a revenue code. It switched from billing as an office visit for treatment. And they switched it to outpatient hospital services.”

Blanzy’s clinic is now owned by Corewell Health, a large health system that is the result of a merger in 2022.

At the end of 2023, Corewell announced to patients that some clinics would now be owned and operated by hospitals.

In December 2023, Blanzy received a letter from Corewell Health about the billing changes, stating that she can expect to see two charges on her statements in the future, and the clinic will begin provider-based billing.

The letter also stated that even though the clinic or practice Blanzy went to may be located several miles away from an actual hospital, the facility itself may be owned by the hospital or considered part of it. Corewell’s letter added, “This is common in large health systems where the hospital system owns the space and employs some of the team members.”

Blanzy argues that she did not see the letter when it was sent to her because it only appeared on her My Chart app, an app, she says, she only checks for her lab test results. Blanzy requested the hospital system re-bill her insurance using the “in-office” code as she received in the past, but they refused to do so.

InvestigateTV reached out to Corewell Health for an on-camera interview.

Corewell Health declined to comment on her case due to patient privacy and did not explain the billing code. A spokesperson confirmed that in late 2023, the neurology office became a hospital outpatient department owned and operated by Corewell Health Grand Rapids Hospitals. They added that patients affected by the change received a MyChart letter and information about hospital billing.

Hospital Charges for Non-Hospital Care

Looking over Blanzy’s bill, Dr. Elisabeth Rosenthal, Senior Contributing Editor of InvestigateTV partner KFF Health News, said that she is not surprised.

Rosenthal said hospital charges for non-hospital care are a concern she hears from patients all the time.

“What has happened, and we see this all over the country, is the doctor’s office where she got the treatment, which was a Botox shot, was suddenly re-branded as a hospital. So, she was getting a hospital facility fee charge or a hospital code,” Dr. Rosenthal said.

In fact, KFF Health News reported that the share of physicians working for a hospital or in a practice owned at least partially by a hospital or healthcare system increased from 29% in 2012 to 41% in 2022.

The U.S. Public Interest Research Group, or PIRG, says hospital billing codes allow for higher payments to support hospital infrastructure, like intensive care units, specialized equipment and other expenses for fully staffed hospitals. Other costs come in what are typically called “facility fees,” flat fees meant to offset these extra costs of maintaining a large hospital, even if you don’t go to the main building.

“And we see this over and over again. The rebranding of doctors’ offices of outpatient clinics as hospitals for the purpose of billing. And it’s, it’s no different, nothing,” Rosenthal said. “So I think it’s another one of our buyer beware warnings in healthcare.”

Some states are working on solutions. Researchers from Georgetown University found that Colorado, Massachusetts, Maryland, Maine and Washington are trying to cut through the confusion of outpatient facility fees.

Maine, for example, has “a public notice requirement,” where providers must notify consumers online and in signage at the facility whether they charge a facility fee.

New York has what’s called “Direct to Consumer Requirements,” where providers cannot bill consumers for a facility fee not covered by their insurance unless they provide the patient advance written notice.

However, many states do not have specific protections. Some advocates are calling for the implementation of what’s called Site Neutral Payments .

“So, basically the payment is determined by the treatment you got, not where it was given. So, whether it was in a hospital or in an outpatient clinic or a doctor’s office—it’s the treatment that determines the charge. And that just seems much, much fairer than expecting patients to kind of figure out, ‘is my doctor’s office now considered a hospital,’” Rosenthal said.

Critics of site-neutral payment reforms, mainly hospital industry representatives, believe those requirements could lead some hospitals to actually scale back or eliminate services at hospital outpatient departments could lead to decreases in revenue for hospitals, ultimately affecting patient care.

As for Blanzy, she can no longer afford to pay more than $1,100 every three months.

Her treatments have stopped while her contractions and muscle spasms continue every day.

As she waits to see a new neurologist, she is hoping that across the board, transparency in health systems changes so the cost of care is the last thing on a patient’s mind.

“ I’d like to see them be more transparent! You know, the bill is mine. I don’t think I can do anything about that. But, I can’t be the only person where this has happened to,” Blanzy said.

InvestigateTV reached out to the Center for Medicare or Medicaid Services, or CMS about the issue. A CMS spokesperson issued the following statement:

When facility fees are covered by the individual’s plan or coverage in connection with essential health benefits provided in-network, cost sharing for those fees is subject to the maximum out-of-pocket limit (MOOP limit). [1] However, when not covered by the individual’s plan or coverage in connection with the provision of essential health benefits, those fees expose patients to financial risk. They are also likely to come as a surprise to the individual. (FAQs about Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation Part 60 (July 7, 2023), available at https://www.cms.gov/files/document/faqs-part-60.pdf .)

Several states have taken, or are considering taking, action to prohibit, limit, or increase transparency around facility fees. The Departments are monitoring this issue, and encourage plans and issuers, and providers and facilities to minimize the burden to participants, beneficiaries, and enrollees that result from imposing facility fees.

While patient privacy protections precludeCMSfrom addressing the specifics of any particular case, we note there are several laws that help to protect a range of people from unexpected medical charges and promote medical cost transparency. For example, the No Surprises Act (NSA) is protecting millions of people from surprise medical bills when they experience an emergency or get care from an out-of-network provider at an in-network facility.

The NSA includes good faith estimate and advanced explanation of benefit requirements. These requirements mean that, under certain circumstances, providers and insurers must give consumers information about expected out-of-pocket costs for health care items and services before care is provided. These requirements are currently in effect for people who are uninsured or don’t plan to use insurance to pay for their care. These estimates are required to include consumers expected out-of-pocket costs for facility fees.

CMS is working with agencies across the Department of Health and Human Services, as well as the Departments of Labor, the Treasury, and the Office of Personnel Management, to implement good faith estimate and advanced estimate of benefit requirements for people who pay for their care with commercial insurance.

Copyright 2024 Gray Media Group, Inc. All rights reserved.

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