Understand My Bill
Billing Information for Provider- and Hospital-based Clinics
According to Medicare guidelines, most of Pine Rest Christian Mental Health Services outpatient clinic locations meet the criteria and have been designated as hospital-based outpatient clinics. According to Medicare billing rules, when you see a provider in a hospital-based outpatient clinic, two separate bills are sent to Medicare and Medicare Advantage Plans. We call this provider-based billing.
Under provider-based billing, there is a professional charge billed out (Part B) and a facility charge billed out (Part A) on two separate claims. Therefore, patients may receive two Explanation of Benefits from their insurance and may be charged two separate coinsurances for their clinic visit.
If a patient has a secondary insurance, we will bill the secondary insurance and balance bill the patient any remaining amount due after the secondary insurance pays.
Since all insurances have different benefits and out of pocket expenses, we encourage you to contact your insurance company prior to your appointment to discuss this.