It's like adding insult to illness. A disturbing story in Thursday's Post-Gazette revealed that some patients with health insurance are charged more than a modest co-pay for a simple doctor's visit.

In the example used by staff writer Steve Twedt, unemployed Munhall resident Diane Aiello had her annual physical done in the Shea Medical Center in the Shadyside Medical Building on the UPMC Shadyside campus. She expected to pay the $25.25 co-pay under her Highmark insurance plan. But she was floored later when billed additionally for a $91.95 "facility fee."

Hospitals say it's to cover office overhead like utilities and maintenance. We say it's outrageous.

UPMC is not the only health care provider tacking on facility fees. So is West Penn Allegheny Health System, Cleveland Clinic and others.

A Highmark spokesman said many individual insurance plans, especially those with high deductibles, don't cover facility fees until the yearly deductible is met. Ironically, those who hold these policies may be the ones who can't afford to be nickel and dimed.

It's hard to see this unsettling trend for anything other than what it is: a creative way for the health-care industry to get around the various limits aimed at keeping insurance costs "down." As a result, it's hard, and maybe impossible, for the average patient to know what her next routine doctor's visit will cost out of pocket.

You wonder how executives in hospitals and insurance companies who saddle patients with facility fees would react to the same surprise with their purchases.

Haircut for $15? Tack on the barber's facility fee of $50 to keep the air conditioning on.

Birthday cake for $22? Don't forget the baker's facility fee of $80 to heat the oven.

Newspaper for 75 cents? Remember the facility fee of $2.80 to power the presses.

It's enough to make you sick. And to think some people still don't believe in health care reform.

Cartoonist Rob Rogers does "Rob's Rough," an early look at his work and his creative process, exclusively at PG+, a members-only web site of the Pittsburgh Post-Gazette. Our introduction to PG+ gives you all the details.