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Guide to Provider-Based Billing

We are changing how medical care, education and research impact the health of people who live in Mobile and the surrounding area.

Our team of doctors, advanced care providers, nurses, therapists and researchers provide the region’s most advanced medicine at multiple facilities, campuses, clinics and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall well-being of our community. As part of our transformation, some locations of USA Health have become provider-based facilities and function as outpatient departments of USA Health Children’s & Women’s Hospital.

What does being provider-based mean for our patients?

Provider-based is a Medicare classification, and it means the facility has met specific Medicare regulations. Most large hospital systems are classified as provider-based by Medicare, and it applies to all patients which results in uniform billing. This decision was made as a result of our desire to increase the quality of care provided to USA Health patients and improve the level of patient service by leveraging USA resources in a new and dynamic way.

How does provider-based apply to billing?

Billing applies to all patients, regardless of the type of insurance you have. The way your insurance covers facility and/or treatment charges will be different based on whether you have insurance through your employer, an insurance company, or if you are covered by Medicare.

How does provider-based apply to employer health plans or other insurance (non Medicare)?

The way your insurance company handles these charges will vary based on your health plan. Some insurance companies may apply these charges to your annual deductible. To find out what will be covered, please contact your insurance company. If you have additional questions about this charge or need help to navigate this charge, call one of our financial counselors at (251) 415-1667.

How does provider-based apply to Medicare?

  • Facility or Hospital Services charges, which will be billed to Medicare Part A.
  • Physician and Clinical Professional charges will be billed to Medicare Part B.
  • You will receive two Medicare Summary Notices (MSNs); one for Part A and one for Part B.
  • If you have secondary insurance, we will submit any balance to that insurance company.
  • If your secondary insurance does not cover the remaining balance or if you do not have secondary insurance, the balance will be billed to you.
    • Medicare requires that we give you an estimate of your Part A and Part B charges if you do not have secondary insurance. These amounts may be different, depending on the services you receive.

What USA Health clinics are provider-based?

As of Nov. 1, 2020, the following locations are provider-based clinics of Children’s & Women’s Hospital

Strada Patient Care Center
Adolescent Medicine
Center for Women’s Health
High Risk Obstetrics
Pediatric Cardiology
Pediatric Developmental Medicine
Pediatric Digestive Health
Pediatric Endocrinology
Pediatric Hematology Oncology
Pediatric Infectious Disease
Pediatric Surgery
Pediatrics
Springhill Pediatrics
Urogynecology

Children’s & Women Hospital
Center for Women’s Health

Center Street
Pediatrics

Thank you.

We appreciate you trusting us with your healthcare needs in the past, and we look forward to continuing to help you and all of our patients lead longer, better lives.

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