Giving Our Patients Options
AdventHealth provides patients with a broad range of treatment options and locations. From inpatient pediatric care to outpatient oncology services our patients have the flexibility to select a treatment plan that works within the constraints of their insurance plan, and is consistent with their physician and location preferences.
Hospital-Based Outpatient Clinics
In order to provide our patients with as many treatment options as possible, AdventHealth provides physician care services in both the private physician office and hospital-based outpatient clinics. Many AdventHealth patient care locations are considered part of the hospital even if they are located miles away from the main hospital campus.
Because these outpatient clinics are part of the hospital you will receive a bill from both the hospital and the office of the treating physician.
Medicare Secondary Payer Questionnaire
As a participating Medicare provider, we must screen patients according to MSP rules. We will ask you the MSP questions at each visit to help us confirm if Medicare or another payer should be the primary insurance to pass your claim.
Treatment at a Hospital-based Outpatient Clinic and Insurance
How treatment at a hospital-based outpatient clinic may impact insurance payment:
- Commercial Insurance
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All services will be billed according to the terms of the insurance agreement. In some cases, this might mean that services provided at the hospital-based outpatient clinic will be billed as if they were provided at a private physician office.
Any amounts you owe will be based on the specific services you receive and your insurance plan benefits.
- Medicare Advantage (In Network)
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Depending on your health insurance plan, you may or may not have higher out-of-pocket costs when receiving care at a hospital-based outpatient clinic.
All services will be billed according to the terms of the Medicare Advantage plan. In some cases, this might mean that services provided at the hospital based outpatient clinic will be billed as if they were provided at a private physician office.
Any amount you owe will be based on the specific services you receive and your medicare Advantage plan benefits.
- Medicare Advantage (Out of Network)
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Claims will be bulled to the out of network Medicare Advantage plan under the Medicare Free for Service methodology described above.
Patients will have a higher coinsurance amount for services at a hospital-based outpatient clinic than those same services at a private physician practice due to the two charges (hospital/facility and physician/professional).
- Medicaid and Medicare Fee for Service
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Medicaid program billing requirements, including coinsurance amounts, vary by state. You will be billed according to the individual state plan requirements for a hospital-based outpatient clinic.
Medicare coinsurance (out-of-pocket) costs are based on Medicare's prescribed rates for each of the two charges: hospital/facility and physician/professional.
Medicare patients will have a higher coinsurance amount for services at a hospital-based outpatient clinic than those same services at a private physician practice due to the two charges (hospital/facility and physician/professional).
Medicare patients will receive an estimate of actual hospital/facility and physician/professional coinsurance amounts at the hospital-based outpatient clinic location prior to service.
Patients or their secondary insurances are responsible for any co-pays, coinsurance or deductible amounts for both hospital/facility charges and physician/professional services after insurance has paid.