Provider Based Billing at a Clinic

Provider Based Billing at a Clinic is a scam.

Basically this means that the facility bills you seperately from the doctor.

In a hospital setting, this makes sense. You have hospital nurses and other people caring for you, and you have the actual costs of being in the hospital. You also have your doctors, other doctors, etc, who may come visit you and all that, and those individuals may not be hospital employees. So I would expect a bill from multiple entities.

Then there is the LCMC Children's Hospital Clinic. This is a after-hours clinic that is co-located in the same office as a group of Children's Hospital private doctors. You used to pay a single charge when you went. It was treated as if you were just visiting one of their regular pediatricians.

That's changed. Now, you get two bills - one from the doctor that sees you at the clinic, and one from the clinic itself.

The really fun part is... it's both LCMC!! So LCMC sends you a single consolidated bill, that has both the clinic charge and the doc charge on it. (Because the doctor is... an employee of LCMC). But it's technically two bills and two insurance claims.

One claim is for the doctor - this includes the office visit, charge for two tests that were run, and a charge for handling / delivering specimens to the lab. This set of charges results in a contractual write off, an insurance payment, and my co-pay. Fair enough.

The second claim is for the clinic itself. It simply says "services provided". There is a note that says this is related to "nursing care, support and ancillary staff, routine supplies, equipment, and building expenses". Again, I'd buy that if it's a hospital or surgical facility. This is a frickin doctor's office.

The second claim our lovely insurers treat as a hospital claim, which is subject to our deductible, then co-insurance. Since we have not yet met our deductible, we get to pay the full ride for that part of it.

So, what used to be a $25 visit to the doctor, now is $25 plus $28.33 = $53.33. Nothing has changed except how they bill.

It's crap like this, why more and more people are willing to consider single payer.