Frequently Asked Questions
Why do I receive two separate charges for one visit to my doctor’s office?
When a hospital and physicians are working together as one system (sometimes called Provider-Based or Hospital-Based Outpatient care), Medicare allows us to bill separate charges for (1) physician care and procedures done in that office and (2) the nursing, facilities and technology costs necessary for physician care.
You will receive two Medicare Summary Notices (MSNs) from Medicare. Once Medicare has processed and paid their portion of the charges, the remaining balance due will be submitted to your secondary insurance payer, if you have secondary insurance. If you do not have secondary insurance, you will receive a bill for the remaining balance (approximately $10-$60).
Actual amount depends on full amount of services provided.
If you would like to speak to someone about your bill, please call the SMHC Physician Services Billing Department at 207-467-8880.
Why does Medicare require two charges for each physician visit and any procedure done at my physician’s office?
Medicare allows this because they want to ensure high quality care and physician access for patients covered by Medicare. Therefore, any physician office that is part of a hospital/healthcare system must:
- meet all the higher quality standards required of hospitals; and
- accept any patient regardless of ability to pay. This results in higher costs to the health care system, but it ensures access for Medicare patients. Many private, for-profit physician offices limit the percentage of their patients covered by Medicare or MaineCare and those who are uninsured.
My bill showed a Hospital Outpatient Lab Charge, but I never went to the hospital. Why?
Some lab tests are drawn in the physician office and then sent to the hospital or an outside lab for processing. The Hospital Outpatient Lab Charge is the cost of processing the test at the hospital or outside facility.
Is there anything I can do to avoid the additional costs associated with the two-part Medicare bills?
In many cases Medicare patients have secondary insurance that helps cover some or all of the costs of their care. You may wish to consider this if you do not now have secondary insurance. We recommend that patients review their insurance benefits or contact their insurance provider to discuss the coverage available to them.
If you are having difficulty paying for your healthcare services, please contact the SMHC Physician Services Billing Department at 207-467-8880. They can help determine if you qualify for SMHC’s free care program.