If you are receiving care at one of Baylor Scott & White Health's "Provider-Based" locations, there may be a hospital facility charge as well as a physician or other licensed practitioner professional charge for outpatient services or procedures since these locations are considered outpatient departments of the hospital. Consequently, you may be financially responsible for a separate deductible and co-insurance payment for the hospital services, in addition to the physician or other licensed practitioner bill.
Depending on a patient's specific insurance coverage, it is possible that some patients may pay more for services and procedures furnished at a provider-based location than they would at a free-standing facility that utilizes global billing (all technical overhead and professional fees on the same statement). This ultimately depends on charges assessed and type of insurance coverage involved. Baylor Scott & White is not unique in this regard. This is the national model of practice for large, integrated systems where hospitals own facilities treated as outpatient departments under the Medicare requirements and employ the clinical and administrative staff. Under provider-based billing, these locations are considered departments of the hospital and services rendered are billed accordingly. Patients are advised to review their insurance benefits or contact their insurance provider to determine what their policies will cover and identify any out-of-pocket expenses.
How does this affect billing?
Under provider-based billing, a patient receives two bills, one for the hospital service and another for the physician or other licensed practitioner professional service. The hospital bill includes the same procedure code as the physician or other licensed practitioner bill, but the hospital bill covers support staff and services (nurses, medical assistants, etc.), supplies, equipment, and other overhead to perform the procedure or service in the hospital outpatient department. The physician or other licensed practitioner bill covers his/her performance of the procedure or service. Depending on your insurance benefits you may be responsible for a separate deductible and co-insurance for the hospital bill, in addition to the physician or other licensed practitioner bill. In most cases, if you have supplemental insurance it will cover the hospital charge.
In comparison, if a patient is treated by a physician or other licensed practitioner in a freestanding physician clinic, the patient is financially responsible for one bill that includes both the professional fee and practice expenses related to the performance of the professional service.
What can I do if I am having difficulty paying for my healthcare services?
Please contact us or visit our Financial Assistance section to learn more about your financial options.