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Understanding Your Clinic Charges
As of January 1, 2013 most Kadlec Clinic locations became designated “hospital-based” outpatient clinics of Kadlec Regional Medical Center. This includes all primary care locations including; Kennewick, Pasco, Richland, and West Richland as well as the Senior Clinic, Associated Physicians for Women, Kadlec Neuroscience Center and Tri-Cities Nephrology. This designation may affect billing for some patient so below you'll find some information about how this billing change may affect you.
Frequently Asked Questions
What does “hospital-based” outpatient clinic mean?
- This refers to the billing process for services rendered in a hospital outpatient clinic or location.
- This is a national model of practice for healthcare organizations that provide both hospital and physician clinic services to their patients and is consistent with the practices of the other hospitals in the Tri-Cities.
Why does Kadlec Clinic do “hospital-based” billing?
- Since Kadlec Clinic employs physicians and mid-level providers as part of Kadlec Regional Medical Center, we use the same billing process for outpatient care as that rendered at our hospital.
- This process ensures the most appropriate payment for services provided by hospital staff and physicians, and helps differentiate clinic facilities that function as departments of hospitals from those which are freestanding.
Which locations are licensed as “hospital-based” clinics?
- Most Kadlec Clinic locations are “hospital-based” clinics because they are licensed as outpatient departments of Kadlec Regional Medical Center.
- Locations affected include our primary care locations (Kennewick, Pasco, Richland and West Richland) as well as the Senior Clinic, Associated Physicians for Women and Tri-Cities Nephrology.
How does this affect billing?
- Under this model, Medicare and Medicare managed care patients as well as Medicaid and Medicaid managed care (Healthy Options) patients may potentially receive two (2) charges on their statement as well as on their Explanation of Benefits (EOB).
- One charge represents the “hospital-based” facility charge, labeled as “Outpatient Hospital Charge” and the second charge reflects the professional or physician fee. It is important to note that the total amount of these two separate charges is the same as the total amount charged to non-Medicare/Medicaid patients.
Does this mean patients will pay more for services?
- Depending on their particular insurance coverage, it is possible patients may pay more or less for certain outpatient services and procedures at our “hospital-based” outpatient locations than at other types of clinics.
- We recommend patients review their insurance benefits or contact their insurance provider to determine what their policy will pay and what out-of-pocket expenses they may incur for “hospital-based” facility charges.
- Please note some lab tests drawn at freestanding clinics may be sent to a hospital or other facility for processing and also show as an outpatient hospital charge.
Does this affect patient co-pays or deductibles?
- Depending on each patient’s specific insurance benefits, additional out-of-pocket expenses may be incurred by the patient. All patients are encouraged to contact their insurance company to understand their financial responsibility. The amount a patient owes is based on the coverage agreement between the patient and their insurer.
Where can patient call with questions or concerns?
- If you have questions regarding your charges please call the Single Billing Office staff at (509) 942-2626, options 2.
- If you are concerned about your ability to pay your bill and wish to apply for financial assistance please call the Single Billing Office at the number noted above. In addition, financial assistance applications are also available at each clinic.
- If you have questions regarding your insurance coverage for “hospital-based” clinic facility charges please call your insurance company.
For more information about this transition click here to read our Understanding Your Bill Patient Letter.
If you have additional questions about your charges or bill we encourage you to call Patient Financial Services at (509) 942-2626, option 2. Questions related to your coverage for "hospital-based" facility charges should be directed to your insurance carrier.