The following are outpatient departments of the hospital:
- Clinical departments in the North and South clinic buildings on the Urbana main campus
- Except Oral and Maxillofacial Surgery on North Clinic 1
- All clinical departments in the main hospital or on the Urbana main hospital campus
- Expanding Children's Hearing Opportunities Program (ECHO)
- Ambulatory locations at Mahomet, Monticello, Rantoul and Danville on Vermilion
- Occupational Medicine at Danville on Vermilion, for worker’s comp visits only
- Lab and Radiology services at Carle Danville on Fairchild
- Carle Spine Institute
- North Annex
- Occupational Medicine at North Annex, for worker’s comp visits only
- Champaign on Curtis
- Champaign on Mattis
- Urbana on Windsor
- Ambulatory location for Orthopedics and Sports Medicine
- Plastic Surgery Center
- Clinical departments at Carle Outpatient Services at The Fields
- Except Oral and Maxillofacial Surgery
You will be charged for any services performed by your physician, and receive separate charges from the hospital for facility services. Depending on your insurance, there may be an additional co-pay or coinsurance (one for the physician and one for the hospital) for one visit. If you have secondary coverage, any additional co-insurance and deductible may be covered by your secondary insurance. This billing model, called Provider Based, complies with specific Medicare regulations and is a national model of practice for integrated healthcare delivery systems such as Carle.
Frequently Asked Questions
- What is provider-based status?
- What is the 340b program?
- Is this billing process new for Carle?
- Will I have to pay an additional fee for my next visit?
- How will this affect my next visit?
- What if I'm confused about the bills I get in the mail?
- What if I'm having trouble paying my medical bills?
- Why is Carle converting to this model for most of its physician office locations?
What is Provider-Based Status?
Provider Based status is a status sanctioned by Medicare for hospitals and clinics. It is a national model of practice for integrated healthcare delivery systems like Carle that includes hospital and physician offices. Simply put, it means that physician offices are departments of the hospital. One of the benefits of having Provider-Based status is the opportunity to participate in the Federal 340B Drug Purchasing Program.
What is the 340B Program?
By converting most of our physician practice locations to provider-based status, Carle can participate in a program called 340B that extends discounts to hospital providers on some drugs it purchases for use in the hospital outpatient setting. The Federally-designed 340B Program enables approved nonprofit health care organizations to stretch scarce Federal resources as far as possible, reaching more eligible patients and providing more comprehensive services. The discounts available through this program will help reduce overall expenses for drug supplies.
Will I have to pay an additional fee for my next visit?
There will be a facility charge for an office visit that will then be applied to the patient's insurance plan and be billed accordingly. The patient's insurance plan coverage will be applied to both bills and the remaining balances will be billed to the patient - one bill for hospital facility fees and one for physician services. This is no different than the way Carle currently bills for other hospital based services like the Emergency Department, Therapy Services, Lab services and surgical procedures.
How will this affect my next visit?
Provider Based billing will not change your covered services, but it may affect your copayments and deductible.
What if I'm confused about the bills I get in the mail?
If you have questions about your bills, please call Carle Patient Financial Services at (888) 71-CARLE.
What if I'm having trouble paying my medical bills?
Carle has a number of options for those struggling to pay medical bills, including payment plans and free or discounted health care through the Carle Financial Assistance Program. If you'd like to hear more on these options, call Carle Patient Financial Services at (217) 326-3099 or (888) 71-CARLE.
Why did Carle convert to this model for most of its physician office locations?
The rising cost of health care and lower reimbursements prompted Carle to make this change for its physician office locations. The Medicare-approved Provider Based model ensures Carle is compensated fairly for services provided and allows Carle to participate in a federal drug purchasing program that will help lower the total cost of care.
Like all Illinois hospitals, Carle is experiencing significant reductions in reimbursement.
Carle is taking proactive steps to ensure high-quality care is available to the residents of east central Illinois now and in the future. By converting to the provider-based model, Carle is ensuring it is reimbursed fairly for services it provides. By participating in the 340B Drug Purchasing Program, Carle is trying to reduce the supply cost of providing care to patients.