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Hospital-Based Outpatient Clinic

What is a Hospital-Based Outpatient Clinic?

A hospital-based outpatient clinic is considered a department of the hospital. Even if it’s located miles away from the main hospital, it’s still part of the hospital. These clinics follow stricter government rules, which can make things a bit more complex and costly.

When you visit a hospital-based outpatient clinic, it’s as if you’re getting care within the hospital itself—not at a separate doctor’s office. So, if you receive services at Mary Washington Hospital or Stafford Hospital outpatient departments, you may notice hospital charges for outpatient services and/or procedures on your bill.

Understanding Hospital-Based Outpatient Clinics and Billing

  • Private Office Setting:
    • When you visit a physician in a private office, all services and costs are combined into a single charge, according to Medicare billing rules.
    • Your insurance copay usually covers physician services.
  • Hospital-Based Outpatient Clinic:
    • If you see a physician in a hospital-based outpatient clinic:
      • Physician charges and clinic (facility) charges are billed separately, according to Medicare billing rules.
      • Hospital benefits apply to the facility charges, which may include deductibles and coinsurance.
      • Depending on your insurance plan, you might have higher out-of-pocket expenses.

Why Has Mary Washington Healthcare Made This Change?

Mary Washington Healthcare has made a positive change to enhance the way we provide care. Here are some benefits of this improvement:

  • Better Coordination of Care: We’re working together across our healthcare system to make sure your care is seamless. This means improved communication between different parts of our team.
  • Improved Patient Outcomes: Our goal is to help you get better faster. By following standardized processes, we can provide high-quality care that leads to better results for you.
  • Quality Control: We’re committed to maintaining high standards. This change helps us monitor and improve the quality of care you receive.
  • Efficient Information Sharing: Your medical information will be transmitted electronically to specialists and other providers involved in your treatment. This ensures everyone has the right information to give you the best care.
  • Potential New Services: As we continue to improve, we may offer additional services to meet your needs.

Feel free to reach out if you have any questions or need assistance. We’re here for you! You can reach us at 540.741.1041.

How It Works for Patients with Private Insurance

  • Private Insurance Companies:
    • Many private insurance companies such as Blue Cross Blue Shield, United Healthcare, or Aetna don’t follow the same billing rules as Medicare and Medicaid.
  • Physician Services:
    • Generally, physician services are processed under the physician benefits tier.
    • Patients may have co-payments for these services.
  • Hospital Services (i.e. Lab, Radiology, and Other Services or Procedures):
    • These services, provided by the hospital, are billed separately, regardless of your insurance.
    • Hospital services generally fall under the outpatient hospital benefits tier.
    • Deductibles and coinsurance amounts may apply.

Remember, insurance benefits can vary, so it’s essential to understand your specific coverage.

How Does This Affect a Patient Who Has Medicare, Medicare Advantage, or Medicaid?

  • In hospital-based outpatient clinics, Medicare, Medicare Advantage, and Medicaid patients could receive two (2) separate bills for services provided in the clinic—one from the doctor and one from the hospital.
  • For patients covered by Medicare or Medicare Advantage plans, non-physician charges billed by the hospital could be subject to coinsurance, copays, or deductibles.

What If a Medicare Patient Has a Secondary Insurance?

Co-insurance and deductibles may be covered by a secondary insurance. Check your benefits or contact your insurance company for details.

Who Can I Call With Financial Questions or Concerns?

Mary Washington Healthcare has staff available to assist with questions. Please call us at 540.741.1041.

What Can I Do if I Am Having Difficulty Paying for Healthcare Services?

Please don’t hesitate to contact us with concerns. We have different options for different situations and are available to help. Visit our Financial Services page to learn more.