Bone & Joint Center accepts most major health insurance plans and will bill your insurance carrier on your behalf. Patients, however, are responsible for any copayments and deductibles at the time of service. For questions about your insurance coverage, including pre-authorization for services and referrals, please contact your insurance company.
Information for Our Medicare and Medicaid Patients
Thank you for choosing Bone & Joint Center for your health care needs. We want you to have the best care and patient experience, including understanding your bill.
As of March 1, 2016, Bone & Joint Center changed to "Provider Based Billing."
“Provider Based” refers to services provided in hospital outpatient departments that are clinically integrated into the hospital. The clinical integration allows for high quality and seamlessly coordinated care.
To help you understand your bill, here are some common questions that patients might ask.
What is Provider Based Billing?
Provider Based billing is a Medicare and Medicaid billing status. It refers to services provided in hospital outpatient departments that are clinically integrated into the hospital. It requires that we bill Medicare/Medicaid in two parts: one bill for the provider you see (your doctor), and another bill for the hospital/facility (staff, equipment and resources). The charges add up to the same amount that patients are charged for the same service.
How will Provider Based Billing affect my bills?
Patients may receive two (2) bills for services: One for the facility or hospital charge and one for the professional or physician fee. You will be able to see these charges on the patient statement you receive after the services have been provided.
Will I pay more for services with Provider Based Billing?
Some patients may pay more depending on the specific insurance coverage. 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 they may incur.
Most patients insured by a government program who also have supplemental insurance will likely not pay more out-of-pocket. If you do not have a supplement, you will likely pay some amount. Check with your insurance plan to see what will be covered.
What is different about billing for a hospital based outpatient clinic?
According to Medicare/Medicaid billing rules, when you see a physician in a private office setting, all services and expenses are bundled into a single charge. When you see a physician in a hospital-based outpatient location, the physician and clinic (facility) charges are billed separately. Your billing statement will break out your charges for each office visit or service. Part of the total is for the main person you see (your doctor). The rest is for the place (building, support staff, equipment and other resources). The charges will add up to the same amount a patient would be charged, but they are listed separately on your bill.
Why does Holland Hospital do "Provider Based” billing?
This is the standard billing practice for health care organizations where the hospital owns space and employs physicians who provide patient care. It also distinguishes facilities that function as departments of hospitals from those which are independent.
Does this affect Medicare/Medicaid patient co-pays or deductibles?
If you are covered by Medicare and Medicaid, you may see two (2) separate charges on your bill. There will be one charge for the facility and a separate charge for professional or physician services. Patients with Medicare insurance coverage may be billed two (2) co-insurance amounts depending specific insurance benefits. Patients with Medicaid insurance may pay two (2) co-pays.
Depending on specific insurance coverage, it is possible that some benefits may differ for these services and procedures. Some patients may have to pay a higher cost because a portion of the billed service is being charged as a hospital charge. The increase in cost is a result of the health plan’s co-insurance and deductible (not an increase in actual fees). Patients with a supplement plan are not likely to see much change.
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.
Will appointments be different?
Your care will not change. You will continue to see your regular doctor and health care team and continue to receive excellent quality care. Scheduling appointments and tests will be handled as they have been in the past.
What if a Medicare patient has a secondary insurance?
Coinsurance and deductibles may be covered by a secondary insurance. Check your benefits or ask your insurance company for details.
Where can I call with billing questions?
Please contact the Bone & Joint Center billing office at (616) 394-3626 if you have questions.
What can you do if you are having difficulty paying for health care services?
Please contact the Bone & Joint Center billing office at (616) 394-3626 for financial assistance information.
Bone & Joint Center
3299 North Wellness Drive
Building C, Suite 150