Billing Information for Hospital-Based Clinic Care

To help you understand your bills, here are answers to questions patients often ask.

What is a hospital-based clinic?

A hospital-based clinic is a department of the hospital. (This type of clinic also is called a hospital-based outpatient clinic or provider-based clinic.) Because it must follow the same strict government rules for safety and quality as hospitals, it is more complex and costly to operate. When you see a health care provider or receive services in a hospital-based clinic, you are receiving care that meets hospital standards.

Health care systems throughout the county have hospital-based outpatient clinics, which are approved by Medicare.

What clinics are considered hospital-based clinics?

In early 2019, many Great River Health clinics will become Medicare hospital-based clinics. A few of the clinics have been hospital-based for several years.

Current hospital-based clinics:

  • Hematology and Oncology - Great River Medical Center
  • Radiation Oncology - Great River Medical Center
  • Wound and Hyperbaric - Great River Medical Center

Clinics becoming Medicare hospital-based clinics in 2019:

  • Family Medicine - Great River Medical Center
  • Family Medicine, Mercy - Great River Medical Center
  • Cardiology - Great River Medical Center
  • Eye Specialists - Great River Medical Center
  • Medicine Specialists - Great River Medical Center
  • Mental Health - Great River Medical Center
  • Nephrology - Great River Medical Center
  • Orthopaedic Specialists - Great River Medical Center
  • Pre-Surgery - Great River Medical Center
  • Pulmonology - Great River Medical Center
  • Surgeons - Great River Medical Center
  • Urology - Great River Medical Center
  • Women's Health - Great River Medical Center

Will I be paying more for services?

Depending on your health insurance coverage, you may pay more for some outpatient services and procedures at hospital-based clinics. Patients are responsible for co-payments, coinsurance or deductible amounts for both professional and facility charges after insurance has paid.

We advise you to call your health insurance provider to determine what your out-of-pocket expenses will be, if any, before receiving service.

Ask your health insurance company:

  • Does my insurance benefit plan cover hospital/facility charges in a hospital-based outpatient clinic?
  • How much of the charge is covered?
  • How much will be applied to the deductible?
  • How much will I owe out-of-pocket (coinsurance) after meeting the deductible?


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

Commercial insurance

Insurance plans vary. Please call your health insurance provider.

What is the facility/hospital charge on my doctor bill? I didn’t go to the hospital.

When you receive service at a hospital-based clinic, you could receive two bills:

  • Great River Medical Center – This bill is for use of the clinic, supplies and support staff.
  • Great River Physicians and Clinics – The bill is for the health care provider’s services only.

Why did my insurance company pay more than you charged?

To help control costs, health care providers and insurance companies agree on preset payment amounts for inpatient and outpatient care. These per case payments are based on the health problem and treatment, and patient age and gender.

Per case payments help control costs by encouraging care providers to deliver care efficiently. In most cases, per case payments are equal to or less than the amount charged. But in some cases, the payments are greater than charged.

Where can I call with financial questions or concerns?

If you have questions about a bill you have received, please call Patient Financial Services at 319-768-3625, option 2. If you have questions about insurance coverage, please contact your health insurance provider.

Why is Great River Health converting most of its clinics?

The health system is taking proactive steps to ensure high-quality care remains available in southeast Iowa. Like all Iowa hospitals, Great River Medical Center is experiencing significant reductions in reimbursement. At the same time, health care costs continue increasing. Moving to hospital-based outpatient clinics helps ensure we are compensated fairly for the services provided.