Surprise! Your health care provider added a fee for that questionnaire you filled out

 Novant Health is among a growing number of health care systems now charging patients for self-administered surveys that screen for problems. Patients say they should not be billed for checking a few boxes

When Steve Hardman of Charlotte checked in to see a Novant Health sleep doctor earlier this year, the receptionist handed him a survey to fill out.

Hardman, 66, had seen the questions before — Do you feel safe in your house? Can you afford food? He spent a few minutes checking off the answers and handed the form back to the front desk.

A few weeks later, the bill arrived, and it included an extra $8 fee he hadn’t seen before.

Thinking it must be a mistake, Hardman called Novant’s billing office. The billing representative told him the fee was connected to the questionnaire he had completed.

Hardman was shocked, especially since no one at Novant had talked to him about the survey or his responses.

“You are asking people if they feel safe, if they can afford food. Then you charge them,” he said. “In what world does that actually make sense?”

He said it sounded like a strategy to boost revenue: “It’s only a small amount, but you multiply that by I-don’t-know-how-many patients — probably millions every year — and that’s a nice add to the bottom line.”

A national trend

Across the country, hospitals have started charging for self-administered questionnaires — brief surveys that screen for depression, food insecurity, domestic violence or other risks, said Caitlin Donovan, senior director at the Patient Advocate Foundation, a patients’ rights nonprofit.

The screenings are supposed to flag patients who need extra support, but many people don’t learn about any potential fees until the bill arrives. 

Donovan said she has talked to patients from multiple states frustrated that they were billed for checking a few boxes. She said it’s part of a broader billing trend her organization has noticed of health care systems billing for items that used to be included in the visit, whether it’s a facility fee or a charge for messaging your doctor.

“They’re screening for mental health or safety, and that’s incredibly important, but it should be part of the fee for the visit, not an add-on,” Donovan said. “They know if it’s a small-enough amount, most people probably just pay it.”

Novant: Surveys help patients

When asked about the charges, a Novant Health spokesperson said in an email that the survey asking about safety, housing and food security became a billable service in 2024.

“Social determinants of health assessments uncover non-medical factors affecting well-being, connecting patients to social workers, community health workers, and local resources as appropriate,” she wrote.

For example, she explained, patients facing food insecurity are connected to food resources and, if it’s urgent, provided with an emergency pack that includes a four-day supply of food. To date, Novant Health has provided nearly 16,000 emergency food packs, according to the email.

The hospital said most insurance providers cover the assessment, “and the majority of patients pay between $5 and $10.”

UNC Health and Cone Health do similar screenings, but do not charge separately for them, according to spokespeople at each hospital. Other North Carolina health care systems queried by the Charlotte Ledger/NC Health News did not respond in time for publication.

https://www.northcarolinahealthnews.org/2025/12/08/hospitals-charge-fee-for-questionnaire-you-filled-out/