Provider-based Billing

Thank you for choosing to receive your care with us. For our patients who are insured by Medicare, Medicare Advantage and Tricare insurance, we bill services as provider-based billing, sometimes called hospital-based billing.

Provider-based Billing Frequently Asked Questions

What is provider-based billing?

Provider-based billing is common throughout integrated health care systems in the U.S. It is a type of billing for services provided in a clinic or hospital department. Clinics located several miles away from the main hospital campus may be considered part of the hospital.

Patients benefit because all participating hospital facilities must follow stricter quality standards and offer additional resources for patients and their families.

Even though you are seeing your regular health care provider in a clinic setting and not actually hospitalized, your visit is billed under the hospital rather than the doctor’s office.

Will I pay more for services?

In many cases, you will receive a statement with charges split apart for each visit.

• One charge for the professional services from the doctor you see.
• One charge for the facility, which covers the use of the room and any medical or technical supplies, equipment and support staff.

The total billed amount for the visit does not increase — it is simply separated into a professional charge and a facility charge.

However, depending on your insurance benefits, your out‑of‑pocket costs may be different because Medicare and Tricare apply deductibles and coinsurance separately to the hospital (facility) and professional portions of the bill.

Are all patients being billed this way?

No. The requirement for breaking out charges for each office visit was set by the Centers for Medicare & Medicaid Services, which is why only patients with Medicare, Medicare Advantage and Tricare insurance are billed using provider-based billing. At this time, commercial insurance companies do not require this breakout.

What if I have questions?

Review your insurance benefits or contact your insurance provider to determine any changes to what your policy will cover. You can also call 800-640-5339 toll free to speak to billing customer services representative who can answer your questions.

What should I ask my insurance carrier?

Understanding what your insurance plan covers is important to making informed health care purchasing decisions. Ask your insurance company these questions:

• Does my benefit plan cover facility charges in a hospital-based outpatient clinic?
• How much of the charge is covered?
• How much of the charge will be applied to my deductible?
• How much of the charge is subject to insurance?

Which Samaritan clinic locations are provider-based?

All Samaritan clinics that use provider-based billing include one of the following on their sign, letterhead, location page on the website and other materials:

• The hospital logo for which the clinic is licensed under.
• A tagline that says it’s a department of a particular Samaritan hospital.
  • A department of Good Samaritan Regional Medical Center.
  • A department of Samaritan Albany General Hospital.
  • A department of Samaritan Lebanon Community Hospital.
  • A department of Samaritan North Lincoln Hospital.
  • A department of Samaritan Pacific Communities Hospital.

Does provider-based billing affect me if I have insurance through my employer or some other form of commercial insurance?

This billing applies to all patients, regardless of the type of insurance you have.

The way your insurance company covers the hospital service part of your bill varies. It’s based on whether you have insurance through your employer, another insurance company, or if you’re covered by Medicare. Some insurance companies cover this part of your bill, while others apply it to your deductible.

Contact your insurance company to understand your benefit design. If you have questions, call billing office to speak to a customer service representative at 800-640-5339.

I have supplemental coverage in addition to Medicare. Will it cover my hospital services?

Samaritan Health Services will submit any balance to your secondary insurance company. If your secondary insurance doesn’t cover the remaining balance (or if you don’t have secondary insurance), you’ll get a bill for what you owe.