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Provider-Based or Hospital-Based Outpatient Clinics FAQs

Below are frequently asked questions related to Rutland Regional Medical Center’s transition to hospital based physician clinics:

What does “Provider-Based”or “Hospital Outpatient Clinic” mean?

A “Provider-Based” or “Hospital Outpatient Clinic” refers to services provided in hospital outpatient departments that are clinically integrated into a hospital. The clinical integration allows for higher quality and seamlessly coordinated care. “Provider-Based” status is a Medicare status for hospitals and clinics that meet specific Medicare regulations and requires that we bill Medicare in two parts – one bill for the physician service, and another bill for the hospital/facility resources and services.

What Payers does Rutland Regional contract with in-network?

The Payers Rutland Regional Medical Center contracts with are the following:

  • Aetna (for Bayada)
  • Blue Cross Blue Shield of Vermont (and Affiliates: CBA and participating BCBS plans)
  • CDPHP (not NY Medicaid Plans)
  • Cigna (and Affiliates: Great West, NALC and APWU. Excluded: Cigna Behavioral Health Plans)
  • First Health (Access Only)
  • Medicare
  • Medicare Advantage Plans (please check with your carrier)
  • Multi-Plan (see full list of PHCS Plans Only on their website)
  • MVP VT Plans (not NY Plans or NY Medicaid Plans)
  • United Healthcare (and Affiliates — Golden Rule, Oxford, VA UHC)
  • US Family Health (Champus, Tricare, Healthnet)
  • VA (Emergent/Urgent or Prior Authorized)
  • Vermont Health Connect Plans
  • Vermont Medicaid

Rutland Regional Medical Center will send a standard bill to any verifiable insurance that is deemed out-of-network. You may be responsible for submitting additional information as requested by your insurance company.

Rutland Regional Medical Center will bill patients for balances where the insurance has deemed that amount as patient responsibility.

What if I have commercial insurance?

You will receive a bill from the hospital for services performed at the outpatient clinic. Each insurance plan is unique and some insurance companies may cover both hospital charges and doctor charges, and some may not.

What should I ask my insurance carrier?

Ask whether the insurance company covers facility charges in an outpatient hospital clinic. If it does, ask what percentage of the charge is covered. Additionally, verify what your hospital outpatient insurance benefits are, as they typically are applied toward a hospital deductible and co-insurance payment.

What if I have an insurance plan such as BCBS?

Insurance carriers who have a contract with Rutland Regional Medical Center may not require the same billing process as plans such as Medicare or Medicaid. You may not incur additional expenses but should check with the business office or your insurance plan.

What if I have Medicare, Medicaid, Medicare Advantage Plans or Tricare?

In a hospital-based outpatient clinic, if you have Medicare, Medicaid, Medicare Advantage Plans or Tricare, you may receive two (2) separate bills for services provided in the clinic — one for physician services and another from the hospital.

Will this affect my co-pays, co-insurance or deductibles?

Depending on the clinical service being provided, additional out-of-pocket expenses may be incurred in the “Provider-Based” clinic.

What if I have secondary insurance coverage?

Co-insurance and deductibles may be covered by a secondary insurance policy. Check with your benefits or insurance company for details related to your secondary coverage. For instance, you may ask whether the secondary insurance company covers facility charges or provider-based billing. If it does, ask what percentage of the charge is covered. Verify what your hospital outpatient insurance benefits are, as they typically are applied toward your deductible and co-insurance.

How will I know if a clinic is “Provider-Based”?

Ask when scheduling your appointment. “Provider-Based” clinics will have signage reflecting that the clinic is a department of Rutland Regional Medical Center and indicates you are walking into a department of the Hospital.

Where can I call with my financial questions or concerns?

If you have questions, please contact Patient Financial Services at 802.747.1751 or toll free at 877.233.4561, or visit the Financial Counselors who are adjacent to the Patient Access Department in the main Hospital building. For patient estimates, please contact the Financial Counselors at 802.747.1648. If you already have received services and have questions pertaining to your statement, please call the telephone number referenced on your bill.

What can I do if I have difficulty paying for healthcare services?

You can contact a Patient Financial Services Representative at 802.747.1751 or toll-free at 877.233.4561 to discuss available options.

Which Rutland Regional Medical Center clinics are “Provider-Based” or “Hospital-Based” departments?

RUTLAND REGIONAL MEDICAL CENTER160 Allen Street, Rutland, VT 05701802.775.7111

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