Answers to common questions, including how to pay your bill.
- Will I receive a separate bill for hospital and provider services I receive at OHSU?
- Why are some patients charged "facility fees" at Oregon Health &Science University (OHSU) outpatient clinics?
- Why is there a separate physician fee?
- Do all outpatient services have facility fees?
- How will I know how much I owe?
- How will my insurance company get billed?
- I do not have insurance. How will you bill me?
- How often will I receive a statement?
- Why are you asking for my deductible, co-insurance or co-payment at the time of my visit?
- Why did my insurance deny the claim?
- How do I make a payment?
- What should I do if I can’t pay my bill?
- What are my financial responsibilities as a patient?
- How do I contact the billing office for questions and/or an itemized copy of my bill?
Will I receive a separate bill for hospital and provider services I receive at OHSU?
You will receive only one statement for both hospital and provider services. If you have received any anesthesia services, you may get a separate statement for these services.
Here's an explanation of your bill
For example, if you have outpatient surgery, you will receive one bill from OHSU for hospital and provider charges and a separate bill from the anesthesiologist.
OHSU follows national guidelines and billing standards mandated by the Center for Medicare & Medicaid Services (CMS) for all patients and all visits – in the hospital setting and in outpatient settings. CMS has defined facility fee insurance billing codes for outpatient "clinic visits" to reimburse hospitals for the level/intensity of the nursing services and hospital resources used in an outpatient clinic setting. The fees take into account the operating and overhead costs related to the building, service provided by our clinical and support staff, supplies and equipment, as well as administrative costs.
Why are some patients charged "facility fees" at Oregon Health & Science University (OHSU) outpatient clinics?
Physicians who treat patients at hospital-owned facilities typically are not owners or employed by those facilities. When billing insurance companies, the physicians accept lower fees/insurance reimbursement than physicians who use their own equipment, supplies, staff and facilities
Why is there a separate physician fee?
Physicians who own their own facility and resources use insurance billing codes that include their facility/overhead costs into a single patient bill for an office visit and are reimbursed at a higher rate by insurance providers.
Do all outpatient services have facility fees?
No, OHSU charges a facility fee only when the service provided meets the definition and criteria established by CMS for a "clinic visit." There are some outpatient services, such as lab, radiology and rehabilitation therapy, that have different codes established by CMS. In those situations, the facility costs are already built in to the reimbursement rate, so patients are not charged a separate fee.
How will I know how much I owe?
Your insurance provider will send you an Explanation of Benefits (EOB) notice that details the amount it has paid, any non-covered or denied amounts and the remaining balance that you are responsible for paying to OHSU. Review your EOB carefully, compare it to your OHSU billing statement and call your insurance provider or an OHSU Customer Service Representative right away if you have questions or concerns.
As a courtesy, we bill both your primary and secondary health insurance carriers. To insure proper and prompt processing of your claim, please be sure to verify the insurance information we have at the time of registration.
If you do not have health insurance, Medicare or Medicaid, we will send you a bill for any balance not paid at the time services are received. Please pay the bill, or call us to make payment arrangements, as soon as you receive it. You may make your payments by check, Visa, MasterCard, American Express or Discover Card.
Statements are issued monthly after we receive payment from your insurance company.
We ask that payments be made at the time of your visit so you won’t be inconvenienced with a statement sent to your home after your visit. It also helps us reduce costs and saves you the trouble of mailing a payment back to OHSU.
Insurance companies should notify you directly when a claim is denied. If you have not received an Explanation of Benefits, you should contact your insurance carrier directly.
The most common insurance denials received on claims are:
- You were not covered by your insurance plan on the date of service
- Service received was from a doctor/facility outside your plan’s network
- No authorization/referral is on file for services
- The service you received was not covered under your plan
- Your insurance carrier needs additional information from you
- The insurance information recorded at the time of service was inaccurate, incomplete or outdated.
More information about financial assistance is available online.
To find out what your insurance plan covers and what your financial obligation may be, call the Customer Services or Member Services Department of your insurance company (the phone numbers are on your insurance card).
Make sure that your insurance company lists both your doctor and hospital as a participating provider. If you go to an out-of-network provider, you may have a greater financial responsibility for services provided that is not under contract with your health care plan. Your insurance company can assist you in finding an in-network provider to limit the amount of money you will have to pay for care. Find the Customer Service department you should contact.