Physician Office and Hospital Outpatient Billing at Partners HealthCare
Physician Office Billing
When your visit takes place in a physician office, you will usually be charged only for the physician’s examination, and your co-payment will usually be your only out-of-pocket cost.
We will request your co-payment when you check in for a visit.
Hospital Outpatient Billing
When your visit takes place in a hospital outpatient location, there will typically be two charges which may result in you paying more for your visit than if you are seen in a physician office. Your out-of-pocket costs could include the following:
- You will be charged for the physician’s examination, which will usually be covered by your co-payment.
- You will also be charged by the hospital for use of hospital space, equipment, and support staff. This is commonly known as a “Facility Fee.” Your health plan may apply these hospital charges to your annual deductible, and after using up your deductible, you may be responsible for a co-insurance payment.
You may receive a bill that combines the charges from the hospital and the physician on one line or these charges may be split into two lines, depending on the location. We will request your co-payment when you check in for your visit, and we will send you a bill for any unpaid balances after we receive payment from your insurance company.
Understanding Whether My Visit is a Physician Office Visit or a Hospital Outpatient Visit
You can find information about whether your visit is a physician office or hospital outpatient visit in notices in our waiting rooms, on the websites of our hospitals and physician groups, and in electronic appointment reminders for your scheduled visits.
Referral and Prior Authorization
For both physician office and hospital outpatient visits, your health insurer may require you to get a referral or authorization. In addition, our providers may be considered “In Network” or “Out of Network” depending on the specifics of your health insurance plan, which could affect the amount you pay.
Billing for Procedures Performed During the Visit
No matter the location, if a procedure is performed during the visit, you may have further out-of-pocket costs for additional physicians’ services and for use of the hospital facilities and staff, even if the procedure was performed in the same exam room as the visit with the physician. Your health plan may apply these additional physician and hospital charges to your annual deductible, and after using up your deductible, you may be responsible for an additional co-insurance payment.
Laboratory and Imaging Services
If your physician ordered laboratory tests or imaging services (such as X-ray, CT or MRI), you may be billed for these tests by the hospital, clinical laboratory, or imaging center, and you may also be billed for the services of the physicians (usually pathologists and radiologists) who interpreted the test results.
Understanding How Much My Visit Will Cost
It is your right to receive an estimate of the cost of your visit in advance of the visit. Please contact Partners Patient Billing Solutions (see below) at least two business days prior to your visit to get an estimate. Please have as many details as possible about the upcoming visit, including the provider name, location, and details of the planned service or procedure.
Special Notice for Medicare Patients
If you are a Medicare beneficiary and your visit takes place in a hospital outpatient location, you will be responsible for a Medicare Part B out-of-pocket co-insurance payment of approximately $25 for the hospital facility charge. Procedure charges or other testing could increase your out-of-pocket expense.
Please contact the Member Services department of your health insurance plan to verify your coverage and financial responsibility for services described on this page. This phone number is usually located on your insurance card.
If Your Insurance Company Does Not Answer all of Your Questions, Please Contact Partners Patient Billing Solutions:
Patient Billing Solutions Partners HealthCare
399 Revolution Drive, Suite 410 Somerville, MA 02145–1462
Monday–Friday, 8:00 AM to 4:30 PM
Updated April 2019