Why Do I Get Separate Bills From the Hospital and Physician?
Understand why hospitals and physicians bill separately for your medical care. Gain clarity on the distinct services and entities involved in your healthcare costs.
Receiving multiple bills after a single medical event can often lead to confusion and frustration for patients. This common experience arises from the standard operational structure of the United States healthcare system. Hospitals function as distinct facilities, while physicians often operate as independent professional service providers, even when working within a hospital setting. This fundamental separation drives the practice of sending separate bills for facility usage and professional medical services.
What Hospital Bills Cover
Hospital bills cover facility-related costs. These charges encompass the use of physical space, including operating rooms, recovery areas, and hospital beds. The bill also includes expenses for essential medical equipment and supplies.
Beyond physical resources, hospital bills cover support staff, including nursing care. Administrative overhead also contributes to the charges. An itemized hospital bill might also list charges for laboratory tests, imaging services, and procedures performed within the facility.
What Physician Bills Cover
Physician bills detail professional fees for services rendered by medical doctors. These include charges for medical diagnoses, consultations, and surgical procedures.
Physician charges also cover the interpretation of diagnostic tests. Post-operative care is also billed by the physician or their practice group. Patients often receive separate bills from multiple physicians involved in their care, such as surgeons, anesthesiologists, radiologists, and pathologists.
Reasons for Separate Billing
Separate billing stems from the distinct legal and financial structures of hospitals and physician groups. Hospitals and physician practices often operate as independent business entities, each with its own federal tax identification number and billing department. This organizational separation means they negotiate separate contracts with insurance companies.
This structure allows for specialized billing, differentiating facility use from professional expertise. For example, a hospital bills for the technical component of an X-ray, while a radiologist bills separately for the professional component. Many medical specialties, such as anesthesiology, pathology, and emergency medicine, are often delivered by independent physician groups that contract with hospitals, leading to separate billing.
Managing Multiple Bills
Upon receiving medical bills, review the Explanation of Benefits (EOB) sent by your insurance company. The EOB is a detailed statement outlining covered services, provider charges, insurer payments, and your financial responsibility, including deductibles, co-pays, or coinsurance. Comparing the EOB with the bills helps identify discrepancies and clarify your financial obligations.
Understanding common terminology on bills, such as Current Procedural Terminology (CPT) codes for procedures and International Classification of Diseases (ICD) codes for diagnoses, helps verify services. If a bill lacks detail, requesting an itemized bill provides a line-by-line breakdown of all charges. If any charges remain unclear or appear incorrect, contact the billing department for clarification or dispute resolution. Maintaining organized records of all medical bills, EOBs, and communications is important for effective financial management.