Infusion Clinic vs Hospital: Why the Bill Is Different
There are three common places to get an infusion: a hospital outpatient department, a doctor's office with its own infusion suite, and an independent infusion center. The nurses, pumps and drugs are often the same. The bill is not.
Facility Fees
Hospitals can bill a separate facility fee for your visit, and they often get paid more for the drug itself. Independent clinics and doctors' offices bill under the physician fee schedule, which is usually lower. That difference shows up in your coinsurance.
Why Insurers Push Patients to Clinics
Because of that gap, many commercial insurers have site-of-care rules that require some patients to move from a hospital to a clinic or to home infusion after the first doses. If you get a letter like that, it is not a change in your treatment, only where you get it.
When the Hospital Makes Sense
- Your first dose of a drug with a high risk of reaction.
- You need other hospital care at the same visit.
- No clinic nearby gives your drug or takes your plan.
How to Switch
Find a clinic near you that gives your drug, call to confirm they take your insurance, and ask your doctor to send them a new order. The clinic redoes the prior authorization and schedules you once it is approved.