Provider-Based FAQ
The Following are Outpatient Departments of the Hospital:
- Wabash General Hospital General Surgery Office
- Wabash General Hospital Oncology Office
- Wabash General Hospital Orthopaedic Office (Mt. Carmel location)
You will be charged for any services performed by your physician or mid-level provider and receive separate charges from the hospital for facility services. Depending on your insurance, there may be an additional co-pay or coinsurance (one for the provider and one for the hospital) for one visit. If you have secondary coverage, any additional co-insurance and deductible may be covered by your secondary insurance. This billing model, called Provider-Based, complies with specific Medicare regulations and is a national model of practice for integrated healthcare delivery systems such as Wabash General Hospital.
Frequently Asked Questions
What is Provider-Based Status?
Provider-based status is a status sanctioned by Medicare for hospitals and clinics. It is a national model of practice for integrated healthcare delivery systems like Wabash General Hospital that includes hospital and physician offices. Simply put, it means that physician offices are departments of the hospital. One of the benefits of having provider-based status is the opportunity to participate in the Federal 340B Drug Purchasing Program.
What is the 340B Program?
By converting most of our physician practice locations to provider-based status, Wabash General Hospital can participate in a program called 340B that extends discounts to hospital providers on some drugs it purchases for use in the hospital outpatient setting. The Federally-designed 340B Program enables approved nonprofit health care organizations to stretch scarce Federal resources as far as possible, reaching more eligible patients and providing more comprehensive services. The discounts available through this program will help reduce overall expenses for drug supplies.
Will I have to pay an additional fee for my next visit?
There will be a facility charge for an office visit that will then be applied to the patient's insurance plan and be billed accordingly. The patient's insurance plan coverage will be applied to both bills and the remaining balances will be billed to the patient - one bill for hospital facility fees and one for physician services. This is no different than the way Wabash General Hospital currently bills for other hospital-based services like the Emergency Department, Therapy Services, Lab Services, and surgical procedures.
How will this affect my next visit?
Provider-based billing will not change your covered services, but it may affect your copayments and deductible.
What if I'm confused about the bills I get in the mail?
If you have questions about your bills, please call Wabash General Hospital at 618-262-8621.
What if I'm having trouble paying my medical bills?
Wabash General Hospital offers a Charity Care Program and the Illinois Uninsured Discount. You may qualify for assistance if you do not have any insurance coverage, do not qualify for government assistance for health care and you meet certain income guidelines. If you feel you are qualified, call our Business Office at 618-262-8621 to make an appointment. You will be asked to provide proof of income.
Why did WGH convert to this model for most of its physician office locations?
The rising cost of health care and lower reimbursements prompted Wabash General Hospital to make this change for its physician office locations. The Medicare-approved provider-based model ensures Wabash General Hospital is compensated fairly for services provided and allows us to participate in a federal drug purchasing program that will help lower the total cost of care.
Like all Illinois hospitals, Wabash General Hospital is experiencing significant reductions in reimbursement. Wabash General Hospital is taking proactive steps to ensure high-quality care is available to the residents of southern Illinois now and in the future. By converting to the provider-based model, Wabash General Hospital is ensuring it is reimbursed fairly for services it provides. By participating in the 340B Drug Purchasing Program, Wabash General Hospital is trying to reduce the supply cost of providing care to patients.
