“Hospital Outpatient Department” refers to medical services rendered in an on-site hospital operated outpatient clinic or other hospital affiliated clinic location. This is in contrast to traditional medical clinics that are not hospital based, or hospital affiliated. When you receive services in a hospital outpatient department clinic, you are considered to be treated within the hospital rather than a physician’s office. This is a national model of practice which falls under federal guidelines for large integrated health care delivery systems like Providence. These practices are designated for integrated healthcare delivery systems like Providence, in which the hospital owns the practice and employs the staff involved in patient care versus the Medical Group which owns and operates the traditional medical clinics within Providence.

Under the hospital-based model, patients often receive two charges on their combined bill for services provided within the clinic. One is the “facility/hospital” charge and the other is the “physician (professional)” charge. When you see a physician in a clinic that is not considered “hospital outpatient”, they bundle services into a single charge. Please note that some clinical lab tests may be sent to the Medical Center for processing and would show a hospital outpatient lab charge.

Since Providence is an integrated care system, billing processes are expected to align for services that occur across the organization. Aligning these billing practices not only allows us to provide some of these services in the outpatient setting, it also ensures proper coverage and reimbursement as it pertains to your individual insurance plan.

Depending on insurance coverage, it’s possible that you may pay more for services at hospital-based outpatient location versus a traditional medical clinic. We recommend patients contact their insurance provider to determine what their policy will pay and what out-of-pocket expenses may incur.

Depending on each patient’s specific insurance benefits, additional out-of-pocket expenses may be incurred under the “hospital outpatient department” model. If you want to know what costs might impact you, contact your insurance company prior to scheduling medical services.

For more information, you may contact our Billing Support offices.

In keeping with our mission, Providence’s financial assistance program provides free and low-cost care to those who are eligible. This includes people who don’t have health insurance, as well as those who do have insurance but are unable to pay their out-of-pocket costs. In addition to free and low-cost care, Providence offers interest-free, long-term payment plans and assistance in securing health coverage.

Contact us to learn more about financial assistance or to talk to a Financial Counselor.