Your Guide to Provider-Based Billing

This brochure explains how you are billed for services so that you will know what to expect and can plan for out-of- pocket costs.

What is a ‘provider-based facility’?

The care and services at this clinic are delivered as a service of a Henry Ford Health hospital. It is simply at a different location from the hospital. Medicare calls this type of clinic a “provider-based facility,” and this impacts the way Medicare calculates your bills and copays. It may also affect your out-of- pocket costs, if you do not have Medigap or secondary/ supplemental insurance to make up the difference.

As a provider-based facility, the clinic is held to the highest standards for quality and safety and must follow strict regulations. It’s part of your doctor and hospital working together to provide you with the best possible care and services.

How will I be billed for today's services?

The Centers for Medicare and Medicaid Services require us to send separate bills for the hospital and the medical professional providing the care.
So, the charge for certain services will be divided into two parts:

• A facility fee for the hospital
• A professional fee for the health care professional

May I get an estimate for my coinsurance payment?

It is our goal to be up front with you about Medicare coinsurance amounts, and we will provide you with an estimate. These amounts will vary based on the type and number of services received, for example:

If you have supplemental insurance coverage, it will usually cover the Medicare coinsurance amounts shown above. Our Pricing Department can provide you with more specific estimates. See below for information.

We also provide typical coinsurance amounts for commonly performed procedures in our provider-based facilities. If you have supplemental insurance, your coinsurance costs are usually paid by that insurance.

Does provider-based billing affect how much I pay?

Your health plan coverage generally determines the amount of your out-of-pocket cost. Facility and
professional fees may appear together on the same bill, or they may arrive on two separate bills for the same visit. You may also receive two Medicare Summary Notices or Explanations of Benefits for the same visit.

How can we help you?

If you are confused about your bill, we will do our best to walk you through it step by step.

Our main concern is to make sure you continue to receive the care and services you need. If paying your medical bill is a concern, let us know. We may be able to help.

For your specific hospital, click on the links below: 

• Henry Ford Hospital
• Henry Ford Jackson Hospital
• Henry Ford Macomb Hospital
• Henry Ford West Bloomfield Hospital
• Henry Ford Wyandotte Hospital