Provider-Based or Hospital-Based Information - Applies to Medicaid or Medicare Patients Only
Medicaid or Medicare Patients: Receiving care at Billings Clinic’s “Provider-Based” locations may result in a facility charge as well as a professional or physician charge for outpatient services and/or procedures. These charges will be reflected on the patient statement you receive for services provided.
Depending on a patient’s specific insurance coverage, it is possible that some patients may pay more for these services and procedures than they would at one of our other sites. Billings Clinic is not unique in this regard as this is the case in many integrated health care delivery systems across the country.
Frequently Asked Questions about Provider-Based or Hospital-Based Outpatient Billing
Q: What does “Provider-Based” or “Hospital-Based Outpatient” mean?
A: “Provider-Based” or “Hospital-Based Outpatient” refers to the billing process for services rendered in a hospital outpatient clinic or location. This is the national model of practice for large, integrated delivery systems involved in patient care.
Q: How does this affect billing?
A: Under this model, patients may potentially receive two (2) charges on their combined patient bill for services provided. One charge represents the facility or hospital charge and one charge represents the professional or physician fee.
Q: Why does Billings Clinic do “Provider-Based” billing?
A: Since Billings Clinic employs many physicians, following this same type of billing process for outpatient care rendered at our hospitals ensures more appropriate payment for services provided by hospital staff and physicians and distinguishes facilities that function as departments of hospitals from those which are freestanding.
Q: Does this mean patients will pay more for services?
A: Depending on their particular insurance coverage, it’s possible patients may pay more for certain outpatient services and procedures at our provider based/hospital outpatient locations than at one of our other sites. We recommend patients review their insurance benefits or contact their insurance provider to determine what their policy will pay and what out-of-pocket expenses may incur. Please note some lab tests drawn at a freestanding clinic may be sent to a hospital or other facility for processing and also show a Hospital Outpatient Lab Charge.
Q: What are Billings Clinic’s “Provider-Based” or “Hospital-Based Outpatient” locations?
A: Billings Clinic hospital-based locations:
- Billings Clinic Downtown
- Billings Clinic Orthopedics and Sports Medicine
- 27th Street Medical Building (including Billings Clinic Behavioral Health, Billings Clinic Occupational Health, Billings Clinic Anti-Coagulation Clinic Billings Clinic Cardiology)
- Billings Clinic Heights
- Billings Clinic West
- Billings Clinic Surgery Center
- Billings Clinic Research Center
Q: Does this affect patient co-pays or deductibles?
A: Depending on each patient’s specific insurance benefits, additional patient out-of-pocket expenses may be incurred by the “Provider-Based” model.
Q: Where can patients call with their questions or concerns?
A: Billings Clinic’s Patient Financial Representative at 406-238-2250 or 1-800-332-7156, ext. 2250.
Q: What can patients do if they are having difficulty paying for health care services?
A: Billings Clinic offers financial assistance options. Detailed information is available online or by calling Billings Clinic’s Patient Financial Representatives at 406-238-2250 or 1-800-332-7156, ext. 2250.
For more information on “Provider-Based” or “Hospital-Based Outpatient” billing please contact our Patient Financial Representatives at 406-238-2250 or 1-800-332-7156, ext. 2250.
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