Provider-Based Facilities

What is a Provider-Based Facility

Medicare recognizes the benefit of an integrated system where the hospital and your doctor’s office work together to provide the care and services you need. Hospital-owned clinics also have to meet additional quality standards. “Provider-based facility” is a special Medicare designation that rewards this collaboration and compliance by reimbursing both the hospital and the doctor’s office for your visit. Capturing this additional reimbursement helps us minimize the impact of Medicare reimbursement shortfalls so that we can continue to provide you high quality care.

How Does this Affect My Bill?

All care and services at our office will be provided as a service of MyMichigan Medical Centers. Your bill will come from the Medical Center, and you will make your payments to the Medical Center.

The charge for each service will be divided into two parts – a facility fee for the hospital and a provider fee for the doctor or medical professional. This is similar to the way billing is done in other hospital departments, such as Radiology or Emergency. These charges may appear together on the same bill, or they may arrive on two separate bills for the same visit. You may also receive two Medicare Summary Notices or explanations of benefits for the same visit.

Medicare requires us to bill the hospital fee to Part A and the provider fee to Part B. Depending on your plan, this may result in additional copays and/or deductibles, which could increase your out of pocket costs. Our Customer Service team can help you estimate your costs. In order to provide an estimate, they will ask you what type of procedure or visit you are planning and whether you have met your Part A and Part B deductibles for the year. You may reach them at (989) 488-5815 or toll-free at (844) 832-1956.

If you have secondary or supplemental insurance, we will submit any balance that is not covered by Medicare to that additional insurance plan. If your secondary insurance does not cover the balance, or if you do not have secondary or supplemental insurance, we will bill you for the balance.

MyMichigan Health Provider-Based Facilities

The following provider offices are departments of our Medical Centers. 

Sample Out of Pocket Costs

To help you anticipate your costs or better understand your bill review the average co-insurance amounts for our most frequent billed services. Your actual out of pocket costs my differ, depending on your plan and whether you have met your Part A and Part B deductibles for the year. If you have secondary or supplemental insurance, it may also cover some of these costs.

If you are a patient at one of the above locations, our billing customer service staff can also help you estimate your costs prior to service or answer any questions you may have about your bill. You may reach them toll free at (844) 832-1956. In order to provide you an estimate, they will ask you what type of procedure or visit you are planning, what insurance plan you have, and for Medicare beneficiaries, whether you have met your Part A and Part B deductibles for the year.