Facility Charges

What is a facility fee?

EvergreenHealth bills a facility fee for visits to its clinics that are considered hospital-based. This additional bill, or facility fee, is a charge to cover a portion of the expenses of hospital-based departments where enhanced specialty services are necessary. These expenses are necessary in order for EvergreenHealth to continue to offer these services. Facility fees represent the cost for hospitals like EvergreenHealth to sustainably provide specialty services.

What is a hospital-based department?

The hospital-based departments at EvergreenHealth are licensed outpatient facilities of the hospital campus. An outpatient department is a hospital department where services are provided or procedures are performed, but where the patient's visit is of a shorter duration than an overnight hospital stay. Advantages to a hospital-based clinics include maintaining performance standards through Joint Commission accreditation, attracting high-quality physicians for your care, enabling a higher level of coordination with other providers and services, and ensuring high standards for safety and quality of care.

How can a facility fee affect me?

As an outpatient department of the hospital, our charges for services are separated into two components: a professional fee for the services provided by the physician or advanced practitioner, and a facility fee to cover the costs associated with the building, supplies, equipment, and support staff.

You will receive one bill for your visit with these two charges itemized or two separate bills, one for the professional fee and the other for the facility fee.

The facility fee related to your hospital-based service may result in a higher out-of-pocket expense than if you received similar services in a private physician office. This is because you may have a copay, or a deductible amount responsibility, for each of the bills. It is important to check with your insurance company to find out the patient responsibility percentage for a facility fee in a hospital-based department.

Some insurance plans have different payment rates and policy benefits for facility vs. clinic charges.

• If you have Medicaid: and there is an amount remaining on your bill after Medicaid pays the facility fee, you will not be billed for the balance.
• If you have Medicare: you may have higher overall out-of-pocket costs in a hospital-based department setting than in a private physician office where services and professional fees are bundled in a single claim.
• If you have other insurance: it is important to contact your insurance company to find out the patient responsibility percentage for a facility fee in a hospital-based department. You may have higher overall out-of-pocket costs, or you may not. The coverage provided by commercial insurance companies varies from plan to plan. Therefore, the amount for which the patient is responsible will also vary.

For your convenience, you can visit our Insurance Plans and Coverage web page for a list of accepted insurance plans.

Why and when does EvergreenHealth do hospital-or provider-based billing?

EvergreenHealth does hospital-based, or provider-based, billing because there are certain services that require a higher level of care coordination. For these areas, EvergreenHealth provides care in a clinically integrated setting, with access to all the extra services mentioned prior.

Whether or not the physician providing services is employed by EvergreenHealth isn't the determining factor for hospital-based or provider-based billing. It is dependent on the type of service provided and whether it requires an extra level of care coordination.

Does this mean patients will pay more for services?

Depending on a person's particular insurance coverage, it is possible patients may pay more for certain outpatient services and procedures at EvergreenHealth's hospital-based department locations than at one of our other sites.

For this reason, we recommend 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.

We understand the importance of transparency in healthcare costs. Before your visit, we can provide you with a cost estimate for the services you will receive. Visit our Guest Price Estimate tool where you will have access to cost estimates for services that can be scheduled in advance, helping you make informed decisions about your care. You can also access our price estimate tool through your MyChart account. Don't have a MyChart account? Sign up here.

Does this affect patient co-pays or deductibles?

It can, depending on a patient's specific insurance benefits. Additional patient out-of-pocket expenses may be incurred through the hospital- or provider-based model, because of the possibility of a co-pay or deductible responsibility for each of the bills.

What can patients do if they are having difficulty paying for health-care services?

If you’re facing challenges covering your healthcare expenses, please reach out to us. Providing health care to individuals who may have difficulty paying is part of our mission; we are committed to ensuring you receive the care you need regardless of your ability to pay. When possible, we encourage you to ask for financial help before receiving medical treatment. You may qualify for free or discounted care based on family size and income, even if you have health insurance.

Where can I get more information?

For questions regarding a facility charge on your billing statement, possible financial assistance or payment plan options, call us at (425) 577-7119, (360) 794-1495 or toll-free 1 (855) 480-7451.

In Summary

We are dedicated to providing the best care possible for our patients as well as creating a better understanding of the cost of care, including the driving forces behind current cost increases and shrinking reimbursement rates from insurance companies for the care we deliver.

Receiving care at EvergreenHealth's hospital-based department locations may result in a facility fee as well as a professional or physician charge for outpatient services and/or procedures. These charges will be reflected on the patient statement you receive for services provided. Depending on a patient's specific insurance coverage, it is possible that some patients may pay more for these services and procedures than they would at one of our other sites. EvergreenHealth is not unique in this regard as this is the case in many integrated health-care delivery systems across the country.