Understanding Provider-Based Billing

Provider-based billing applies to care delivered at a hospital outpatient clinic or provider location designated as a “department of the hospital.” This type of billing may include separate charges for both the hospital facility and the physician services provided.

Why Provider-Based billing?

Provider-based billing is commonly used by healthcare systems across the U.S. It benefits patients by ensuring participating hospital facilities meet higher quality standards and provide additional resources to support patients and their families.

Are All Patients Billed Using Provider-Based Billing?

The requirement to itemize professional services and facility charges separately applies exclusively to the Centers for Medicare & Medicaid Services. Only patients with Medicare, Medicaid, Medicare Advantage, or Medicaid HMO plans receive bills showing separate professional and facility charges. For all other insurance health plans and networks, charges are combined and billed as a single amount.

How Will This Impact My Bill?

Your out-of-pocket costs for certain outpatient services and procedures at our provider-based/hospital outpatient locations may be higher, depending on your insurance plan. We recommend reviewing your insurance coverage or contacting your insurance provider to understand what your policy covers and any potential out-of-pocket expenses.

Will There Be A Change In How I Receive Care?

No, you will still receive the same excellent care from the doctors you know and trust. Appointment and test scheduling will remain unchanged.

What If I Need Financial Assistance?

If you are not be able to pay for part or all of your care, we may be able to help. Review our financial assistance programs.

Who Do I Contact For Billing Questions?

If you have questions regarding a Provider-Based bill, call (843) 777-5377.