Hospital-Based Clinics

Facts About Hospital-Based Clinics

Many insurance plans pay for health care services provided in a hospital-based clinic differently than those provided in a doctor’s office.

Your insurance may require that you meet your annual deductible and/or require that you pay a percentage of the bill rather than just an office visit co-payment. You should check with your insurance company if you have any questions.

Most Hennepin County Medical Center clinics are considered hospital-based clinics by the Centers for Medicare and Medicaid Services (CMS). This designation means that your billing statement will be divided into two separate charges for services provided in the clinic, including:

  1. A facility fee from the hospital
  2. A provider fee for his or her professional services

Q: What is a hospital-based clinic?
A: A hospital-based clinic is a clinic that is owned and operated by a hospital. It is common for large, integrated health care systems like HCMC, where the hospital owns or leases space and employs support personnel involved in patient care, to operate hospital-based clinics.

Q: Which HCMC Clinics are hospital-based clinics?
A: All HCMC clinics except the Golden Valley Clinic, Richfield Clinic, St. Anthony Village Clinic, Parkside Occupational and Contact Dermatitis Clinic and the BeWell Clinic are hospital-based clinics.

Q: How does this affect billing?
A: When you receive care you may receive two separate itemized bills. One represents charges related to the facility fee(s), including the cost of nursing staff, supplies, equipment, and building expenses, and the other represents the provider related fees.

Q: Will I pay more for services provided at a hospital-based clinic?
A: Each patient’s insurance plan is unique to that patient and contracted provider. Your insurance plan may cover the services differently for a hospital-based clinic, which could impact what you pay out of pocket. Some insurance companies may cover both the facility fee and provider fee and some may not. If not, all or a portion of the facility portion may be your responsibility. We recommend that you review your insurance benefits or contact your insurance provider to determine what your policy will pay and whether you will need to pay additional out-of-pocket expenses, such as deductibles or coinsurance payments.

Q: What should I ask my insurance provider?
A: Making informed healthcare purchasing decisions is important. Ask whether they cover facility charges in a "Hospital-Based Outpatient" or "Provider-Based" location. If they do, ask how much of the charge is covered or will be applied to your deductible. Also verify your co-pay responsibilities for the type of visit.

Q: Who can I contact with financial questions or concerns?
A: If you have questions about your bill, please contact Billing Customer Service at 612-873-3073.

If you would like to obtain a price estimate before visiting an HCMC clinic or scheduling a procedure, please call the price estimate line at 612-873-9500.

Hennepin County Medical Center offers a variety of programs if you are having difficulty paying for your health care services. Please refer to our patient billing and accepted insurance plans or contact a financial counselor at 612-873-2767.