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What is Provider-Based Billing?

Some clinics at Emory Healthcare have converted to hospital outpatient departments which may result in changes to how you are billed. We’ve collected common questions and resources to help you understand what this means for your care and billing statements.

About Your Care

Will my appointments change?
Your appointment location will not change. Billing associated with your appointment will include a facility fee in most cases.

Do telemedicine appointments also require facility fees?
No. Telemedicine appointments do not include facility fees. Sometimes, a telemedicine visit is an option for your care. Based on your healthcare needs, your care team will determine if telemedicine visits are available for you.   


About Your Billing Statement

What does provider-based billing mean for my bill? 
Bills for hospital outpatient departments will include a new facility fee charge. This change is a result of Emory Healthcare converting some clinics to hospital outpatient departments. With a hospital outpatient department, a facility fee may be added to your insurance plan’s deductible and your co-insurance may apply.  

  • The new hospital outpatient department facility fee considers the use of the space, equipment, supplies, and staff (nurses, medical assistants, etc.) that are needed to operate the clinic. The facility fee may be subject to the patient’s insurance plan deductible and their co-insurance.  Amounts vary between insurers.  
  • The professional fee represents charges for the professional services provided by the physician, nurse practitioner, or physician’s assistant.  

Depending on your insurance policy, you may see the facility fee charge applied to your insurance plan’s deductible and/or co-insurance. If you have an annual out-of-pocket maximum, these charges will apply only until you have met that amount. Some patients may have to pay a higher out-of-pocket cost.  

What is a facility fee?
The facility fee represents the costs of operating a building/facility for hospital outpatient services and covers the cost of equipment, utilities, maintenance, supplies, and medications administered during a clinic visit.  

What is a professional fee?  
The professional fee represents charges for the professional services provided by the physician, nurse practitioner, or physician’s assistant.  

I didn’t visit the hospital. Why am I being charged a facility fee?  
Hospital outpatient departments include a separate facility fee. This is normal among local and national healthcare organizations, like Emory Healthcare, where a hospital owns and operates an outpatient department and employs the support personnel involved in patient care. This means hospital outpatient departments located several miles away from the main hospital campus may be considered part of the hospital.  

How does this change affect my deductible?  
In many cases, patients will see higher bills until their deductibles are reached, and in some cases, patients will reach their deductibles earlier in the year than previously. Because different insurance providers add charges in different ways, your individual experience will be unique to you. Contact the pricing line at 855-432-3080 or 404-686-0260 for an estimate or you can access Emory’s price estimator tool.

My insurance company directed me back to Emory Healthcare for my questions. Who can I contact?  
If you have questions after receiving your bill, please contact our billing department at 404-778-7318 or send a message through your MyChart patient portal. They can help you with financial resources such as payment plans and provide additional details on your charges.


Estimates & Financial Resources

How can I find out what my bill will be before my visit?   
Contact the pricing line at 855-432-3080 or 404-686-0260 for an estimate or you can access Emory’s price estimator tool.  

Does Emory Healthcare provide estimated costs?   
Yes, Emory Healthcare offers two ways to provide estimated costs. Patients can contact the pricing line at 855-432-3080 or 404-686-0260 for an estimate or they can access Emory’s price estimator tool.   

If you have questions after receiving your bill, please contact our billing department at 404-778-7318 or visit www.emoryhealthcare.org/patients-visitors/insurance-and-billing/billing-information. You can also send a message through your MyChart patient portal.  

If you are self-pay or not using insurance, you should receive a good faith estimate prior to your visit. 

I have Medicare. What information will I receive for estimated costs? 
Medicare patients will receive a coinsurance notification advising them of any out-of-pocket costs anticipated at each visit.  

What do I do if my bill is higher than I expected?   
If you have questions or concerns about your bill, please contact our billing department at 404-778-7318 or send a message through your MyChart patient portal. This team can assist you with financial resources such as payment plans and provide additional details about your charges.   

Does Emory Healthcare offer any financial resources?   
Yes. Emory Healthcare offers payment plans and financial resources that include financial assistance for those who qualify under Emory Healthcare’s patient financial assistance policy. If you would like to apply for financial assistance, set up a payment plan, or discuss other financial options, please call 404-778-7318 or send a message through your MyChart patient portal. 


About Provider-Based Billing

Why is Emory Healthcare making this change?  
Provider-based billing is common when a hospital owns and operates an outpatient department and employs the support personnel involved in patient care. This change is consistent with other clinics within Emory Healthcare, including Winship Cancer Institute. 

How will patients be notified of this change?
When departments at Emory Healthcare are changed to hospital outpatient departments, our care teams notify our patients in several ways. These include:   

  • A mailed letter before the change  
  • Signage posted in our facility  
  • Verbal notification when scheduling an appointment   
  • A signed form during check-in for your appointment   
  • Text message appointment reminders  
  • Patient portal message 
  • Updated signage and registration materials