Blessing Health System consists of medical clinics, hospitals and other facilities that serve the health care needs of people in our region. The community-based providers enable patients in the region to receive the highest-quality health care close to home.
When a Medicare and Medicare Advantage patient receives care from a department that is part of Blessing Hospital, rather than another member of the health system, the federal government now requires showing hospital-based charges separate from other provider charges that may be included on the bill.
The change is called provider-based billing, sometimes called hospital-based billing.
Provider-based billing includes a professional fee (clinic charge) and a technical fee (hospital charge) for services provided in an outpatient clinic that is considered part of the hospital. Clinics located within the hospital or even several miles away from the main hospital campus may be considered part of the hospital. Even though you’re seeing your regular physician in a clinic setting and not actually hospitalized, your visit is billed under the hospital rather than the physician’s office.
Blessing Health System consists of hospital based and non-hospital based providers and services.
This is the national model of practice for health care networks; the hospital owns space and employs support staff who assist other providers from within the network with the delivery of patient care. It has been adopted by many medical centers locally and nationally. This benefits patients, as all departments of the hospital are subject to strict quality standards and are monitored by organizations that accredit and certify health care organizations and programs in the U.S. Blessing Hospital is accredited by DNV-GL Healthcare, a world-leading certification body.
Provider-based billing affects services provided by the cardiology clinic, diabetic clinic, wound clinic, breast center, radiation oncology and medical oncology.
In many cases, you will begin seeing a statement with charges split apart for each visit. One charge will be a professional fee (clinic charge) mentioned above, and the other will be a technical fee (hospital charge) mentioned above. Depending on your specific insurance coverage, it is possible that some benefits will differ for these services and procedures. Some patients may have to pay a higher cost because a portion of the billed service is being charged as a hospital charge. The increase in cost is a result of the health plan’s coinsurance and deductible, so not an increase in actual fees. People with a supplement plan are not likely to see much change.
No. The requirement for breaking out charges for each office visit, to reflect services provided by hospitals separately from other types of healthcare providers, was set by the Centers of Medicare and Medicaid. So, only patients with Medicare, Medicare Advantage, Tricare and Medicaid insurance are billed using provider-based billing. At this time, commercial insurance companies do not require this breakout.
Your clinical care will not change. You will continue to see your regular doctor and health care team, and continue to receive excellent quality care. Scheduling appointments and tests will be handled as they have been in the past.
We ask you to review your insurance benefits or contact your insurance provider to determine any changes to what your policy will cover. In addition, we have trained staff who can help answer your questions. Call 1-855-354-5896.
Making informed health care purchasing decisions is important. Ask your insurance company if your benefit plan covers facility charges in a hospital-based outpatient clinic and how much of the charge is covered or will be applied to your deductible or subject to insurance.
We offer financial assistance to help qualifying patients. Information is available by calling Patient Financial Services at 1-855-354-5896.
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More information about provider based billing is available by calling Patient Financial Services at 1-855-354-5896.