Patient Bill of Rights
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Please print and complete the form below.
If you have questions, please call 913-378-1365.
Hospital-Based or Provider-Based Outpatient Billing
Receiving care at Blue Valley Hospital’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 statements that you will receive for services provided (from the facility as well as the professional providing service).
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 a free-standing facility which provides global billing (all facility and professional fees on the same statement). This ultimately depends on charges assessed and type of insurance coverage involved. Blue Valley Hospital is not unique in this regard, as this is the case in many integrated health care delivery systems. Patients are advised to review their insurance benefits or contact their insurance provider to determine what their policy will cover and identify any out-of-pocket expenses.
More information on Provider-Based Status
What does “provider-based” or “hospital outpatient” billing mean?
“Provider-based” or “hospital outpatient” billing refers to the billing process used for services provided in a hospital outpatient clinic. This is where the physician is employed by the hospital and the hospital owns the space and provides support staff for the physician.
How does this affect my billing?
Patients may receive a charge from the hospital and the physician in a hospital outpatient clinic. If a patient has insurance, each patient’s insurance plan is unique to that patient and contracted provider. Some insurance companies may cover both hospital charges and doctor charges and some may not.
How does this affect a patient who has Medicare or Medicaid?
In a hospital based clinic, Medicare and Medicaid patients may receive two separate bills for services provided in the clinic- one from the doctor and one from the hospital. Medicaid patients may have 2 copayments. Depending on the clinical service being provided, additional out-of-pocket expenses for Medicare and Medicaid patients may be incurred in the “Provider-Based” clinic.
What if a Medicare or Medicaid patient has secondary insurance coverage?
Co-insurance and deductibles may be covered by a secondary insurance policy. Check with your benefits or insurance company for details related to your secondary coverage. For instance, you may ask whether the secondary insurance company covers facility charges or provider-based billing. If it does, ask what percentage of the charge is covered. Verify what your hospital outpatient insurance benefits are, as they typically are applied toward your deductible and coinsurance.
Receiving care at Blue Valley Hospital’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. Your insurance plan will determine the impact this has on your out-of-pocket expenses. Blue Valley Hospital is not unique in billing this method.
Patients are advised to review their insurance benefits or contact their insurance provider to determine what their policy will cover and identify any out-of-pocket expenses. For more information please contact our business office at 913-378-1365.