Finding & Using Health Insurance

Health insurance helps you pay for your health care costs. Having insurance can help protect you from high medical costs, and it may help cover expenses if you need unexpected care. It also can make it easier to have routine doctor visits and preventive care. Insurance sometimes helps pay for prescription medicine costs.

Financial Assistance

• Hospital bills your insurance does not completely cover could be discounted for you through our financial assistance.
• You can receive financial assistance even if you have insurance.

Concord Hospital Accepts Most Major Health Insurances

It's always best to call your insurance company directly to verify a provider is in-network for your specific insurance plan. The following is a list of the major health insurances we accept. If you don't see your health insurance company listed or your particular plan's product listed, call your insurance company to verify.

Know Your Health Insurance

• You are responsible for understanding your insurance benefits.

• Not all services may be covered or paid in full.

• Make sure your policy requirements have been satisfied, and that you or your physician obtain any necessary referral, pre-certification or authorization.

Provider-Based or Hospital-Based Outpatient Clinics FAQs

Provider-based or Hospital Outpatient Clinic refers to services provided in a hospital outpatient department including a medical office that is clinically and financially integrated with a hospital or hospital system. Patients benefit from clinical integration because it allows for higher quality and seamlessly coordinated care.   

Some of the benefits of clinical integration:

• Medical record integration with the main hospital;
• Access to all services of the main hospital;
• Main hospital monitoring and oversight;
• Coordination among physicians, clinical staff, and leadership;
• Quality oversight by the Centers for Medicare and Medicaid Services (CMS) accrediting organizations.

Provider-based status is a Medicare status for hospitals and clinics that are clinically integrated and meet other specific CMS requirements. 

What is provider-based billing?

Hospital outpatient departments that have provider-based status bill Medicare and Medicare Advantage (Part C) plans in two parts – one bill for the physician service, and another bill for the hospital/facility resources and services. This billing model is also known as hospital outpatient billing. This billing model is used by many clinically integrated (hospital and medical office) healthcare systems across the nation. The Centers for Medicare and Medicaid Services (CMS) has separate payment programs for provider-based billing and require hospitals to make it clear to patients which healthcare services are part of the hospital (provider-based) and which are not.  

How does provider-based billing affect the billing process?

If you have Medicare or a Medicare Advantage (Part C) plan, your explanation of benefits (EOB) and billing statement(s) for each visit or service will show:

• One charge for the professional services rendered by the provider you see; and
• One charge for the facility, which covers the use of the room and any medical or technical supplies, equipment and support staff. 

Both charges add up to the same amount that would be charged to a patient without Medicare for the same service.  

Are all patients billed using provider-based billing? 

The requirement to separately list professional services and facility charges for each office visit or service is required by the Centers for Medicare and Medicaid Services (CMS). Only patients with Medicare and Medicare Advantage plans are billed with the separately listed professional service and facility charges. 

Other payors, such as commercial insurance companies, do not require charges to be shown and billed separately. 

Will provider-based billing increase the cost of care for Medicare and Medicare Advantage covered patients? 

The cost of care will depend on the particular insurance coverage and services provided. Additional out-of-pocket expenses may be incurred in the provider-based clinic. Insurance benefits may be different for certain outpatient services at a provider-based billing location. Some Medicare patients may be covered by supplemental insurance and may not have to pay more out-of-pocket. 

Medicare beneficiaries are responsible for deductibles and co-insurance. These amounts are determined by Medicare and based on the services performed. You will need to review your insurance plan to determine what is covered and what you are responsible for. 

How will I know if a clinic is provider-based?

Provider-based clinics have signage reflecting that the clinic is a department of Concord Hospital and indicates you are walking into a department of the Hospital. You may also ask when scheduling your appointment. 

Which Concord Hospital locations are provider-based? 

• Anticoagulation Clinic – Concord Family Medicine
• Anticoagulation Clinic – Internal Medicine
• Concord Hospital Cardiology – Concord & Laconia
• Concord Hospital Cardiothoracic Surgery
• Concord Hospital Medical Group Weekend Access
• Concord Hospital Urologic Institute – Concord
• Concord Dermatology
• Concord Endocrinology
• Concord Family Medicine
• Concord Hospital Otolaryngology – Concord & Laconia
• Concord Hospital Obstetrics and Gynecology
• Concord Plastic Surgery
• Concord Pulmonary Medicine
• Concord Surgical Associates
• Epsom Family Medicine
• Family Health Center – Concord & Hillsboro/Deering
• Family Physicians of Pembroke
• Family Tree Healthcare -  Hopkinton & Warner
• Infectious Disease
• Internal Medicine
• Concord Hospital Neurology – Concord
• Penacook Family Physicians
• Pleasant Street Family Medicine
• Concord Hospital Sleep Center
• Concord Hospital Vascular Surgery – Concord
• Concord Hospital Wound and Hyperbaric Center – Concord