Provider-Based Billing and Facility Fees

UW Health is an integrated health system consisting of hospitals and clinics working together to fulfill our mission of remarkable patient care, research, education, and community service. UW Health has clinic locations that are owned and operated by UW Hospitals and Clinics and clinic locations owned and operated by UW Medical Foundation.

 

Sites owned by UW Hospitals and Clinics are considered outpatient departments of the hospital, sometimes referred to as "provider-based" clinics. This is common in large health care systems. Clinics located several miles from the main hospital campus may be considered part of the hospital, even though you are being seen in a clinic setting and not actually hospitalized. When services are provided by a provider-based clinic, a portion of the billed service is charged as a hospital charge with a facility fee.

 

UW Hospitals and Clinics-Owned Locations (Provider-Based Locations)

  • American Family Children's Hospital Clinics (1675 Highland Ave.)
  • Digestive Health Center (750 University Row)
  • East Clinic (5249 E. Terrace Dr.)
  • Hand and Upper Extremity Rehabilitation Clinic (1 S. Park St.)
  • Kidney Clinic (3034 Fish Hatchery Rd.)
  • Lymphedema and Venous Edema Clinic (1 S. Park St.)
  • Oakwood Geriatrics Clinic (6209 Mineral Point Rd.)
  • Pain Management Clinic (1102 S. Park St.)
  • Rehabilitation Clinic (6630 University Ave.)
  • Research Park Clinic (621 Science Dr.)
  • Union Corners Clinic Physical Therapy (2402 Winnebago St.)
  • University Hospital (600 Highland Ave.)
  • University Station Clinic (2880 University Ave.)
  • UW Carbone Cancer Center (600 Highland Ave.)
  • UW Health at The American Center (4602 Eastpark Blvd.)
  • Waisman Center (1500 Highland Ave.)
    • Exception: Autism Treatment Programs
  • West Clinic (451 Junction Rd.)
  • Women's Pelvic Wellness (202 S. Park St)
  • Yahara Clinic Orthopedic Physical Therapy (1050 East Broadway)

Frequently Asked Questions

 

How will this affect the billing process?

Because care is provided in a department of the hospital, patients will see two charges on their UW Health combined statement. One charge will be for the professional services provided by your physician. This is also called the professional fee. One charge will be for the facility charge.

 

Will I pay more for services?

Your health plan may have different benefits when services are provided at a hospital outpatient department (provider-based clinic). Some patients may have to pay a higher cost because a portion of the billed service is being charged as a hospital charge with a facility fee. 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 based on the location of the services provided.

 

What is a facility fee?

Provider-based clinics charge facility fees to cover the higher costs of operating these departments in compliance with the requirements of the Centers for Medicare and Medicaid Services and The Joint Commission. This fee is for costs associated with your visit, including supplies, the services of nurses, therapists, social workers, pharmacists, technicians and other clinical and clerical staff, as well as the cost of training health care professionals at our facility.

 

How much is the UW Health facility fee?

UW Health's facility fee is $166.

 

Will my appointment be different?

No. Patients will continue to receive excellent quality care with their physician. Scheduling appointments and tests will be handled as they always have been.

 

Are there UW Health clinics that do not charge facility fees?

Yes. The University of Wisconsin Medical Foundation owned clinics are not hospital outpatient departments, so they do not charge facility fees. Please note that not all sub-specialties have providers at a UW Medical Foundation clinic.

 

Can I get an estimate?

We can estimate your out-of-pocket costs through our Priceline department at (608) 263-1507.

 

I have more questions, who can help me?

We want you to understand your medical bills. Please call (877) 565-0505 with any questions.