What is a provider-based facility?
Sheridan Memorial Hospital is in the process of moving many of its clinics to a provider-based model.
In practice, this connection allows you to benefit from higher standards of accreditation and oversight, since provider-based locations must meet the same regulatory and safety requirements as the hospital itself.
What does this mean for my bill?
Your visit will be processed in two parts and may result in two separate explanations of benefits from your insurance provider:
- A facility fee, which covers the cost of maintaining hospital-level equipment, staffing and safety standards.
- A professional (provider) fee, which covers the services provided by your physician or clinician.
Most insurance plans recognize and cover both types of charges, but your out-of-pocket costs — such as copays, coinsurance or deductibles — may be different than they would be at a private practice. We encourage you to contact your insurance provider before your visit if you have questions about your specific coverage.
Other frequently asked questions
Provider-based billing allows us to invest in the infrastructure, staffing and technology needed to deliver hospital-quality care in convenient community locations — bringing the same standards you’d expect from our main campus closer to where you live and work.
You may receive separate explanations of benefits for the facility fee and the provider fee, or they may appear together depending on your insurance. Our patient financial services team can walk you through any statement you receive.
This depends on your insurance plan. We recommend checking with your insurance carrier about your specific coverage for provider-based locations, since some plans apply different cost-sharing rules.