Notice of Provider-Based Billing
Ridgeview consists of clinics, hospitals and other facilities that serve the health care needs of the communities we serve. The community-based providers, paired with the resources and expertise of Ridgeview Clinics, enable patients in our communities to receive the highest-quality health care close to home.
For our patients who hold Medicare, Medicare Advantage, Medical Assistance, and Prepaid Medical Assistance Program (PMAP) insurance, Ridgeview bills some services as provider-based billing, sometimes called hospital-based billing.
Frequently Asked Questions
What is provider-based billing?
Provider-based billing is a type of billing for services provided in a clinic or department considered part of the hospital. This often is the case with large health care systems. Clinics located several miles away from the main hospital campus may be considered part of the hospital. Even though you’re seeing your regular physician in a clinic setting and not actually hospitalized, your visit is split to charge your insurance company for the professional fee and the technical fee separately.
Which Ridgeview Clinics locations are billed as provider-based billing?
Provider-based billing affects services provided by Ridgeview Clinics at the following locations: Chanhassen, Chaska, Delano, Excelsior, Le Sueur, Waconia, Westonka and Winsted.
What Ridgeview Clinic locations are excluded as provider-based billing?
Provider-based billing does not affect services provided by Ridgeview Clinics at the following locations: Arlington, Belle Plaine, Gaylord, Henderson and Winthrop. Additionally, services provided within the Ridgeview Spine & Pain location are also excluded.
What is different? Will I pay more for services?
In many cases, you will begin seeing a statement with charges split apart for each visit. One charge will be a professional fee (clinic charge) and the other will be a technical fee (hospital charge). The combined total charge is the same but the components are split.
Depending on your insurance coverage, it is possible that some benefits will differ for these services and procedures. Some patients may be charged a higher fee because a portion of the billed service is being charged as a hospital charge. The increased cost is a result of the health plan’s coinsurance and deductible; it is not an increase in actual fees. Individuals with a supplement plan are likely to see little change.
Will my appointment be different?
Your clinical care will not change. You will continue to see your regular provider and health care team, and continue to receive quality care. Scheduling appointments and tests will be handled as they have been in the past. At every visit, Medicare patients will be asked to complete an Medicare Secondary Payer Questionnaire containing 10 to 15 questions. We recognize this may feel repetitive, but it is a government requirement.
What if I have questions?
We ask you to review your insurance benefits or contact your insurance provider to determine any changes to what your policy covers. In addition, we have trained staff who can help answer your questions. Please call 952.442.8054.
What should I ask my insurance carrier?
Making informed health care purchasing decisions is important. Ask your insurance company if your benefit plan covers facility charges in a hospital-based outpatient clinic and how much of the charge is covered or will be applied to your deductible or subject to insurance.
What can I do if I am having difficulty paying for health care services?
Ridgeview offers financial assistance to patients who meet specific eligibility requirements based on Financial Assistance Policy. Information is also available by calling customer service at 952.442.8054.
