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What does it mean if Northwell Health’s website refers to a medical facility as “division of” or “extension of” a particular hospital?

Northwell Health, like numerous hospitals and health systems across the United States, has several outpatient medical facilities that are part of one of the Health System’s hospitals, even though they may not be located on the same campus as the hospital. These facilities are also sometimes known as “provider-based” facilities. They are licensed outpatient facilities that are regulated as hospitals. When you see a physician or receive services at a provider-based facility, you are a patient of the hospital.

If you are a Medicare beneficiary and are treated at a provider-based facility, will you be billed differently than if you are treated at a freestanding physician’s office?

If you are a Medicare beneficiary and are treated at a provider-based facility, you will typically receive two (2) separate charges for the services you receive. One charge will cover your coinsurance payment and deductible responsibilities for the physician/professional services that you received, and the other charge will cover hospital costs. This type of billing is consistent with the type of bill that Medicare beneficiaries typically receive when they obtain treatment in a hospital. If you are a Medicare beneficiary, the total amount for which you are responsible will typically not be the same as if you were receiving services in a freestanding physician’s office. Your actual out-of-pocket expense may depend on factors such as your Medicare eligibility, your deductible, and any other insurance that you may have.

What if I have commercial insurance?

Many non-Medicare insurance plans do not have the same type of billing requirements as Medicare. We recommend that patients review their insurance benefits or contact their insurance provider to determine what their policy will pay and what out-of-pocket expenses they may incur if they are treated at a provider-based facility.