Insurance and Billing Information

Hospital-based physician practices and Provider-based Billing

We have made some important changes recently in the way we bill our patients and third party payors including insurance companies, Medicare, Medicaid and other governmental programs. These changes are similar to those being made at hospitals and physician practices across the country.

McLaren is taking a more active role in the care delivered in physician offices owned by McLaren where most of our patients’ day-to-day medical needs are met. As a result, McLaren converted many of its physician clinics to hospital-based outpatient clinics. Hospital-based outpatient clinics help increase collaboration between hospitals and physicians by emphasizing better coordination and communication between physician offices and the hospital, focusing attention to quality and clinical outcomes.

Physicians now have access to all your hospital and McLaren physician office medical records to better coordinate your care. Hospital-based outpatient clinics must meet the same stringent level of inspections, regulations and accreditation standards as those of our full service hospitals. These requirements require additional resources. To partially cover the increased costs, Medicare and Medicaid allow the hospital to bill as a “hospital outpatient”. This is known as “provider-based billing”.

If you rely on Medicare, Medicaid or other form of governmental health insurance, these changes will mean that you will receive two bills covering the care that you received

• One for hospital-based services such as x-rays, laboratory work, procedures, supplies, and work of the medical assistant and other office staff (sometimes referred to as a “facility fee”)
• The other for care delivered by the physician, physician assistant, or nurse practitioner. These statements will show any amount owed for the visit, as determined by your insurance plan’s specific benefits.

Hospital-based clinic billing does not affect patients with commercial health insurance plans - only affects those patients with Medicare, Medicaid, or other governmental plans.

As your health care provider, McLaren is committed to offering you the best care possible. We are also committed to helping you understand our financial and billing policies, so if you have questions regarding these billing policy changes, please feel free to contact us.