Provider Based Billing

Thank you for choosing Wabash General Hospital for your healthcare needs. As of July 2011, many of our locations are outpatient hospital departments using Provider Based Billing. Commonly asked questions about Provider Based Billing are answered below.

What is Provider Based Billing?
Provider Based Billing is a type of billing used when services are provided in an outpatient hospital department or location. It breaks out the charges for each office visit or service, with part of the total for the main person you see (your provider), and the rest for the place (building, support staff, equipment and other overhead). The charges add up to the same amount all patients are charged for the same service.

How will Provider Based Billing affect my bills?
When you are seen in an outpatient hospital area, your explanation of benefits (EOB) will break out your charges for each office visit or service. Part of the total is for the main person you see (your provider). The rest is for the place (building, support staff, equipment and other overhead). The charges add up to the same amount all patients are charged for the same service.

Will I pay more for services with Provider Based Billing?
Most patients insured by a government program (Medicare, etc.) who also have supplemental insurance will likely not pay more out-of-pocket. If you do not have a supplemental insurance or have commercial insurance, you will likely pay some amount, as each patient’s insurance plan is unique to that patient and contracted provider. Check with your insurance plan to see what will be covered.

Which WGH locations are provider-based?
Provider and facility charges are split for office visits, tests, procedures, and other services in:

Wabash General Hospital General Surgery Department
Wabash General Hospital Orthopaedic Surgery & Sports Medicine Department (Mount Carmel Location)
Wabash General Hospital Oncology Department

In Summary: Receiving care at Wabash General Hospital’s “Provider-Based” locations may result in a facility charge as well as a professional or physician charge for outpatient services and/or procedures.  These charges will be reflected on the patient statement you receive for services provided.  Your insurance plan will determine the impact this has on your out-of-pocket expenses.  Wabash General Hospital is not unique in billing this way.

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.  For more information, please contact our business office at (618)262-8621.