Appalachian Regional Healthcare System includes outpatient clinics that are actually part of our hospitals – Watauga Medical Center (WMC) or Cannon Memorial Hospital (CMH). Whether these clinics are inside the hospital or offsite away from the main building, the care is provided by the hospital.

When you receive care in a hospital-based outpatient clinic, you are being treated using both physician/provider care and hospital care, which must be billed separately according to Medicare/Medicaid regulations. In a hospital-based clinic, you and/or your insurance company are responsible for physician charges, as well as hospital charges. Free-standing medical offices, on the other hand, can bundle all care and costs into a single charge.

 

Billing and insurance for hospital-based clinics

Because they operate under the hospital’s oversight, an appointment at a hospital-based clinic will be billed like a hospital bill.

Private Insurance: Depending on your health insurance plan, you may or may not have higher out-of-pocket costs when receiving care at a hospital-based outpatient clinic. Patients are responsible for any co-pays, coinsurance or deductible amounts for both hospital/facility charges and physician/professional services after insurance has paid. Any amount you owe will be based on the specific services you receive and your insurance plan benefits. Ask your insurance company:

    • Does my plan cover facility charges in a hospital-based outpatient clinic?
    • How much of the charge is covered?
    • What portion will be put toward my deductible or coinsurance?

Medicare: Medicare or Medicare Advantage coinsurance (out-of-pocket) costs are based on Medicare’s prescribed rates for each of the two charges: hospital/facility and physician/professional. Medicare patients have a higher coinsurance amount for services at a hospital-based facility.

Medicaid: Medicaid patients pay two co-payments, one for hospital/facility charges and one for physician/professional services.

Medicare or Medicaid patients will receive two separate bills: one from the physician or other licensed practitioner treating you and one from Watauga Medical Center or Cannon Memorial Hospital.

Need help? Contact us for help estimating your cost or learn about financial assistance, discounts, and payment plans

Physician/Provider Services

Include but are not limited to:

  • Examinations
  • Interpretations of tests
  • Surgical procedures
  • Consultations performed by physicians and, in some instances, physician assistants and nurse practitioners

Hospitals Services

Include but are not limited to:

  • Laboratory
  • Radiology and other testing services (referred to as ancillary services)
  • Operating room services
  • Emergency
  • Pharmacy
  • Medical supplies
  • Inpatient room and board
  • Other services provided by the hospital