Important Information Concerning Your Bill for Health Care Services

The service you are receiving at Story County Medical Center (SCMC) is considered a “hospital-based outpatient service” according to your private insurance and Medicare guidelines. This means the way the hospital bills for your care and how your insurance company calculates your benefits is different than if you were receiving care at your private physician’s office.

Here are common questions and answers regarding this billing method:

What does “hospital-based outpatient” mean? 

These services are considered part of the hospital, while private physician practices are not. When you seek care from SCMC services such as Physical Therapy, Occupational Therapy, Speech Therapy, Radiology/Medical Imaging, Outpatient Clinics, you are being treated within the hospital rather than the physician’s office.

How does this affect my bill?

According to Medicare and private insurance billing rules, when you see a physician in a private office setting, all services and expenses are “bundled” in a single charge.  When you see a physician in a hospital-based outpatient clinic such as SCMC, physician and hospital charges must be billed separately. Patients may receive one bill from the hospital and another bill from another healthcare provider, such as Unity Point, which would be the service for the physician and/or reading of your radiology images.

Does this mean I will pay more for services in a hospital-based outpatient clinic?

That depends on your insurance plan. You could pay more for your visit depending on your benefit plan, or the visit may be considered part of your annual deductible rather than a service eligible for a co-pay. We encourage you to review your insurance benefits or contact your insurance provider to determine how your policy will pay and what out-of-pocket expenses will be your responsibility. 

What should I ask my insurance company?

Ask whether your plan covers facility charges in a hospital-based outpatient service. If it does, ask what percentage of the charge is covered. Verify what your hospital outpatient insurance benefits are. They are typically applied toward a hospital deductible and coinsurance payment.

What can I do if I am having difficulty paying for health care services?

Story County Medical Center offers financial assistance to help qualifying patients and their families. Please contact the hospital’s Financial Counselor at 515-382-7751.