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Provider/Hospital-Based Outpatient Billing

Frequently Asked Questions

 

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 within a clinic. One charge represents the facility or hospital charge and one charge represents the professional or physician fee.

Q: Why does Geisinger do “Provider-Based” billing?
A: Since Geisinger 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 Geisinger’s “Provider-Based” or “Hospital-Based Outpatient” locations?
A: Click for a list of Geisinger hospital-based locations (.pdf). Other locations will be included as Geisinger expands services to meet patient needs.

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: Geisinger’s Patient Service Call Center toll-free at 1.800.640.4206

Q: What can patients do if they are having difficulty paying for healthcare services?
A: Geisinger Health System offers discounting and charity policies to help qualifying patients. Detailed information is available by calling Geisinger’s Patient Service Call Center toll-free at 1.800.640.4206.

In Summary: Receiving care at Geisinger’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. Geisinger is not unique in this regard as this is the case in many integrated healthcare delivery systems across the country.

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 Patient Service Call Center at 1.800.640.4206 if you have further questions regarding “Provider-Based” or “Hospital-Based Outpatient” billing.