As insurers try to limit costs, providers hit patients with more separate fees

As insurers ratchet down payments to physicians and hospitals, providers are pushing back with a host of new charges. In some cases, the services were never typically covered by health insurance but had generally been performed gratis as part of an exam. In others, the fees are novel constructs. In any case, as insurers and providers fight over revenue in an era of cost control, patients often find themselves caught in the middle, nickel-and-dimed.