Thank you for choosing Mahaska Health for your healthcare needs. We appreciate the opportunity to serve you! Mahaska Health is a critical access hospital serving Mahaska County and the surrounding areas. Receiving care within different departments at Mahaska Health, also known as Hospital Outpatient departments, will result in a hospital facility charge for outpatient services and/or procedures. These charges will be reflected on the patient statement you receive for services provided.
What is provider-based billing?
Provider-based billing is used across the U.S. by many healthcare systems, like Mahaska Health. When you see a physician in a hospital-based outpatient clinic, physician and clinic (facility) charges are billed separately. Hospital-based outpatient clinics are considered a department of the hospital; “private” physician offices are not (generally, these are smaller physician offices out in the community). Hospital-based outpatient clinics are subject to stricter government rules, making them more complex and more costly to operate.
When you see a physician or receive services in a hospital-based outpatient clinic, you are technically being treated within the hospital rather than the physician’s office as these offices are considered a department of the hospital. Even though you’re seeing your regular physician in a clinic setting and not actually hospitalized, your visit is billed under the hospital rather than the physician’s office.
Will I pay more for services?
Your statement will show a separate charge for professional fees (clinic charges), and technical fees (hospital charges), but the combined total will not change. Depending on your specific insurance coverage, it is possible that some benefits will 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 coinsurance and deductible, so not an increase in actual fees. People with a supplement plan are not likely to see much change.
Will my appointment be different?
Your clinical 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. At every visit, Medicare patients will be asked to complete an MSP questionnaire containing 10 to 15 questions. We recognize this may feel repetitive, but it is a government requirement.
What if I have questions?
We ask you to review your insurance benefits or contact your insurance provider to determine any changes to what your policy will cover. If you have additional billing questions, you can contact our Billing Office at 641-672-3315.
What should I ask my insurance carrier?
Making informed health care purchasing decisions is important. Ask your insurance company if your benefit plan covers facility charges in a hospital-based outpatient clinic and how much of the charge is covered or will be applied to your deductible or subject to insurance.
What can I do if I am having difficulty paying for health care services?
We offer financial assistance to help qualifying patients. Information is available by calling our Financial Counselor at 641-672-3315. In addition, we can assist with other county, state or national programs for which you may be eligible.