Doctor visits may soon bring two bills at Carle Foundation Hospital [The News-Gazette, Champaign-Urbana, Ill.]

May 30--URBANA -- Going to see a doctor at Carle? For many patients starting next month, that's going to mean getting two bills instead of one.

Starting June 1, some Carle physician clinics will become outpatient offices of Carle Foundation Hospital. So patients will get two bills -- one from the doctor and one from the hospital.

The hospital bill will be a $205 "facility fee." But insurance coverage will apply, so that's not necessarily what insured patients will pay, according to Carle spokeswoman Jennifer Hendricks.

Carle officials say this switch to "provider-based" billing will help it remain in a financial position to continue providing health care for the community.

"It's a very difficult economic environment," said Dawn Walden, Carle's vice president of revenue-cycle operations. "Carle is being proactive to make sure this gem we have in the Champaign-Urbana area is providing outstanding health care for years and years to come."

How provider-based billing will work: Doctors will remain part of Carle Physician Group and bill for their time, and the hospital will bill for costs involved in the offices, support staff and supplies, Walden said.

Affected June 1 by the extra bill will be patients at Carle's North and South clinics on the central Urbana campus, which includes some primary-care and specialty physicians.

Hendricks said some of the services affected include cardiology, digestive health, maternal fetal medicine, the South Clinic lab and the Expanding Children's Hearing Opportunities (ECHO) program.

Oral maxillofacial surgery will be excluded from the hospital fee, she and Walden said.

Starting July 1, Carle'sChampaign clinics on Curtis Road, Mattis Avenue and Kirby Avenue will be included for the new billing charge, along with the Urbana clinic on Windsor Road, Walden said.

Some Carle physician clinics in places outside Champaign-Urbana will be included in provider-based billing eventually, she said, but a decision hasn't been made yet on which ones.

And, Walden said, "we don't have a firm date when those might transition."

Carle's cancer center and radiology department were already converted to provider-based billing Dec. 1, 2012, without much patient response, Walden said.

"We've had some patients call to ask to explain the bill, but really, it's been a very smooth process," she added.

How much patients wind up paying of the new fee will depend on their insurance coverage, according to Walden.

The "vast majority" of Carle patients have more than one insurance coverage, so they may well end up paying nothing more, she said.

One patient, Mike Swisher, 36, of Tolono, said he inquired about the new billing recently when his nephew got a letter in his bill about it.

Swisher said he called Carle and asked how much the other charge would be and was flabbergasted when someone in the billing office told him $205.

"It's a huge hit, especially for families that have high-deductible plans," he said.

That includes his own family, Swisher said.

Under his health plan, his family has a $6,000 deductible to meet before insurance helps pay, so the second bill would bump the cost of a doctor visit for him and his family -- now $150 -- to $355, Swisher said.

His insurer pays 100 percent for preventive services, Swisher said, but he doesn't know how that will be affected with the additional billing. If he has to begin paying a $205 charge for preventive services, he said, he plans to check out doctors at Christie Clinic, where he also has coverage.

Hendricks said the change to provider-based billing is a Medicare status allowed for integrated providers that offer both a hospital and physician services. It also allowed Carle to apply and be approved for a Medicare purchasing program that will reduce the costs on some drugs used in hospital outpatient settings, she said.

All health care providers are feeling the effect of declining reimbursements from private and public insurance payers, rising costs and declining revenue from patients who can't afford to pay, Walden said.

"We want to stay ahead of the curve," she said.

Carle began notifying patients in mid-May about the change in letters being inserted into their bills, Walden said.

Patients will be called in advance of their appointments to preregister with the hospital, "so when they come in to see the doctor, it's a quick stop at the front desk," she said.

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