What is a facility fee?
EvergreenHealth bills a facility fee for visits to its clinics that are considered hospital-based. This additional bill, or facility fee, is a charge to cover a portion of the expenses of hospital-based departments where enhanced specialty services are necessary.
What is a hospital-based department?
The hospital-based departments at EvergreenHealth are licensed outpatient facilities of the hospital campus. An outpatient department is a hospital department where services are provided or procedures are performed, but where the patient’s visit is of a shorter duration than an overnight hospital stay.
How will the facility fee potentially affect me?
The facility fee related to your hospital-based service may result in a higher out-of-pocket expense than if you received similar services in a private physician office. This is because you may have a copay, or a deductible amount responsibility, for each of the bills. It is important to check with your insurance company to find out the patient responsibility percentage for a facility fee in a hospital-based department.
Some insurance plans have different payment rates and policy benefits for facility vs. clinic charges.
- If you have Medicaid: and there is an amount remaining on your bill after Medicaid pays the facility fee, you will not be billed for the balance.
- If you have Medicare: you may have higher overall out-of-pocket costs in a hospital-based department setting than in a private physician office where services and professional fees are bundled in a single claim.
Download the hospital-based information sheet (PDF)
Download the clinic-based information sheet (PDF)
- If you have other insurance: it is important to contact your insurance company to find out the patient responsibility percentage for a facility fee in a hospital-based department. You may have higher overall out-of-pocket costs, or you may not. The coverage provided by commercial insurance companies varies from plan to plan. Therefore, the amount for which the patient is responsible will also vary.
Why and when does EvergreenHealth do hospital-or provider-based billing?
EvergreenHealth does hospital-based, or provider-based, billing because there are certain services that require a higher level of care coordination. For these areas, EvergreenHealth provides care in a clinically integrated setting, with access to all the extra services mentioned prior.
Whether or not the physician providing services is employed by EvergreenHealth isn’t the determining factor for hospital-based or provider-based billing. It is dependent on the type of service provided and whether it requires the extra level of care coordination.
Does this mean patients will pay more for services?
Depending on a person’s particular insurance coverage, it is possible patients may pay more for certain outpatient services and procedures at EvergreenHealth’s hospital-based department locations than at one of our other sites.
For this reason, 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.
Does this affect patient co-pays or deductibles?
It can, depending on a patient’s specific insurance benefits. Additional patient out-of-pocket expenses may be incurred through the hospital- or provider-based model, because of the possibility of a co-pay or deductible responsibility for each of the bills.
What can patients do if they are having difficulty paying for health-care services?
As a nonprofit healthcare provider, it is EvergreenHealth’s mission to improve the health and well-being of each person it serves, regardless of their ability to pay. To do this, EvergreenHealth offers discounting and charity-care policies to help qualifying patients.
Where can I get more information?
For questions regarding a facility charge on your billing statement, possible financial assistance or payment plan options, call (425) 899-1600.
Receiving care at EvergreenHealth’s hospital-based department locations may result in a facility fee 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. Depending on a patient’s specific insurance coverage, it is possible that some patients may pay more for these services and procedures than they would at one of our other sites. EvergreenHealth is not unique in this regard as this is the case in many integrated health-care delivery systems across the country.