Two incidents -- one at an outpatient facility in Missouri...

A few weeks after Allison Zaromb took her 4-year-old son Meir to see a dermatologist in an outpatient office at the SSM Cardinal Glennon Children's Medical Center campus, she received separate bills from the doctor and the hospital.

The cost for a 3-minute procedure to treat Meir's warts totaled $538, which included a $220 bill for physician services -- and a separate bill for a $318 hospital "facility fee." [That's a grand total of $856.]

Zaromb, a periodontist who lives in University City, is now suing SSM Health Care Corp. and Cardinal Glennon Children's Medical Center in a proposed class action lawsuit on behalf of other patients.

The lawsuit, filed in September in the state Circuit Court of the city of St. Louis, accuses the non-profit hospital system of deceptive business practices -- in particular, violating a Missouri consumer practices statute -- in failing to fully disclose the costs. A judge still must decide whether to certify the lawsuit as a class action.

"No one told me that I would have to pay more than my co-pay before I took my son to that doctor," Allison Zaromb said in an interview. "Had I known they were going to charge a fee beyond my co-pay for the physician, I would not have taken him there."

With the proliferation of hospital-owned outpatient centers and hospital-owned physician practices, hospital "facility fees" have become increasingly common. Such hospital facility fees often involve greater dollar amounts than the fees charged by physicians. And as patients bear a greater portion of their health costs, they are voicing outrage over some of the bills they receive.

...the second at a hospital in Florida:

Every day, patients get a shock like the one on Pearl Beras' hospital bill.

After her two-day stay, the University of Miami Hospital charged the Boca Raton retiree $1,063 for pills that she takes at home for less than $33 – including $71.28 for a 3-cent blood pressure tablet.

"I thought it must be a mistake," said Beras, 84. "How could they do this to a sick person?" She's responsible for the bill because she was in the hospital as an outpatient, and Medicare doesn't cover at-home drugs for outpatients.

Hospital officials realize the big markups give patients sticker shock and are highly unpopular, but said they continue the practice because they must cover costs that do not get billed on their own.