Provider-Based / Hospital-based Outpatient Defined
Meadville Medical Center operates provider-based clinics, also known as hospital-based outpatient departments. Such clinics or departments are considered to be part of the hospital. Federal health care guidelines differentiate clinics that a hospital owns and employs the staff involved in patient care. These provider-based clinics are held to high standards of care and are required to meet federal accreditation standards for hospitals, which are greater than those of physician-based clinics. Our overall goal in utilizing these types of clinics is to preserve access to care in our community for essential services.
Visits to a provider-based clinic result in two charges to the patient:
- one charge for hospital services (the facility fee)
- one charge for physician/professional services
Depending on your insurance benefits, this model may result in higher out-of-pocket expenses.
Provider-Based Clinics Frequently Asked Questions
Below are answers to frequently asked questions related to provider-based clinics. If you would like to speak with a price estimator please call 814-333-5761 and if you have any billing questions please call 814-333-5756.
What does ‘provider-based’ mean?
This term is used to describe clinics that are actually part of a hospital. Clinics located miles away from the main hospital campus may be considered part of the hospital. When you see a physician or receive services in a provider-based clinic, you are being treated within the hospital rather than a traditional physician’s office. Provider-based clinics are held to higher standards. This is a common model of practice for health systems locally and around the nation.
What clinics are or will become a provider-based location?
Behavioral Health
- Mind-Body Wellness Center
Endocrinology
- Mind-Body Wellness Center
Dermatology
- Meadville Dermatology and Skin Surgery Institute
Gastroenterology
- Meadville Gastroenterology
Nephrology
- Center for Hypertension and Nephrology Care
Neurology
- Neurology Center of Meadville
OB/GYN
- Meadville OBGYN
Pain Management
- Meadville Pain Management
- Clinic for Specialty Pain Services
Pulmonology
- Pulmonology of Associates of Meadville
Urology
- Meadville Urology
What is different about patient billing in a provider-based clinic?
According to healthcare billing rules, when you see a physician in a provider-based clinic, physician and hospital charges are billed separately. When you see a physician in a private office setting, all services and expenses are bundled into a single charge. Services provided in provider-based clinics cost more (for nursing, utilities and facilities) which may result in greater out-of-pocket expenses to you.
For patients with insurance, physician services are processed under physician benefits, which are generally subject to patient copayments, while hospital services are processed under hospital benefits and subject to deductibles and coinsurance amounts.
What should I ask my insurance carrier?
Many insurance plans cover facility fees in provider-based clinics. To understand your out-of-pocket costs, ask:
- how much of the charge will be covered?
- what will be applied to your deductible?
- what is subject to coinsurance?
Does this mean patients will pay more for services?
Depending on their particular insurance coverage, it is possible patients may incur more out of pocket cost for certain outpatient services and procedures at our provider based/hospital outpatient locations.
See the previous question for what to ask your insurance carrier, especially if you are covered by a high deductible plan.
What can patients do if they are having difficulty paying for healthcare services?
If patients are having trouble paying a bill, they can contact our patient financial counselor at 814-333-5756. There are many options available. Patients may apply for the hospital’s charity care program, work out a payment plan, or apply for other support services for which they may be eligible.
What if I have Medicare with secondary insurance coverage?
Coinsurance and deductibles are generally covered by secondary insurance. Check your benefits or contact your insurance company for details.
What can I do if I am having difficulty paying for health care services?
Meadville Medical Center offers a variety of options to assist you if you need help in paying for health care services. You may visit a financial counselor in person at several locations or talk with them over the phone at the phone numbers listed above.
AblePay Health members can save up to 13% on their out-of-pocket medical expenses (deductibles and coinsurance). This program is NO-COST and works with any primary health insurance, including Medicare. You can also include family members on your AblePay Account.
Other Billing and Finance Information
Billing & Insurance
The Billing Process at Meadville Medical Center Information Needed at Registration During the admissions and registration process at Meadville Medical Center, you will be asked
Financial Assistance
Financial Assistance Policy Meadville Medical Center offers a financial assistance program for medical care to eligible individuals and families. The financial assistance program is a
Price Transparency
Price Estimator Price transparency is very important and consumers deserve to understand, in advance, what their healthcare will cost. Meadville Medical Center has established a