Important information to remember... • Inpatient Bills
Following an inpatient stay at Denver Health, you will receive separate bills from the hospital and your physician/health care provider(s).
• Bills for Outpatient Specialty Clinic Visits or Follow-up Visits
If you receive your follow-up care at a Denver Health outpatient specialty clinic (such as Orthopaedics, Surgery, etc.), separate bills from the clinic and the physician provider will be sent to your insurance and/or you for payment.
The Facility bill is for the fees associated with the clinic visit, and the physician bill is specifically for the time and professional services of the physician.
Denver Health's clinics are designated as "hospital-based clinics." A hospital-based clinic is a facility similar to a physician’s office. These clinics provide diagnostic, preventive, curative and rehabilitative services that are furnished by an employed physician. The clinic is owned and operated by the hospital. Some insurance companies view services as outpatient clinic visits. You may incur a co-insurance liability at Denver Health that you would not incur if the clinic were not hospital-based.
• Bills for Outpatient Primary Care Clinic Visits
Denver Health's family health centers have a special designation as Federally Qualified Health Centers (FQHCs). This designation helps Denver Health provide primary care services to large populations of Medicaid, Medicare and uninsured patients through governmental reimbursement. There is only one bill that combines facility and professional services that is generated from these clinic visits. Medicare patients may have less out of pocket expenses in these clinics than they would if they went to a private doctor’s office.
What is in the Physician Bill?
The physician bill includes services or procedures performed by your doctor such as medical history, physical examination, and medical decision-making. This bill will also include anesthesiology and surgical services, and/or procedures done in the clinic setting.
What is in the Hospital Bill?
The hospital bill is the facility bill. It covers the care you received from nurses and other support staff. It also includes medications and supplies, room charges, operating room charges and other costs associated with your stay.
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Denver Health and Hospital Authority is a hospital-based provider of medical services. All Denver Health physicians are on staff rather than being in private practice. Under CMS regulations, as well as insurance industry regulations, DHHA sends bills for both the facility and the physician charges.
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As a courtesy to customers, Denver Health bills the designated insurance company directly for most services. Co-pays, deposits, and other co-insurance amounts are due at the time of service.
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Insurance plans have different requirements. Depending on your insurance plan, you may be responsible for the coinsurance related to your care. Coinsurance may be in the form of a copayment, deposit, or paying in full until you meet your deductible for your health insurance. There may be coinsurance related to both the hospital charges and for physician charges, so you may have two different payments due.
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Generally, most insurance companies require a prior authorization or referral for health care costs to be covered. These authorizations may be required for surgery, inpatient stays, observation stays and selected outpatient services.