DWEB-CMS2B

Provider Based Statement

 

Dear Mercy West and North Endoscopy Patients:

The Endoscopy suite at Mercy West and at Mercy North are provider based departments. This means it is associated with Mercy Medical Center - Des Moines and is considered, for insurance purposes, to be an outpatient hospital department. Depending on your insurance coverage, your insurance provider may treat your Mercy Endoscopy visit differently, i.e. copay vs. a coinsurance, than those provided in a doctor's office.

As such, you will receive two (2) separate bills for your visit. Depending upon you insurance benefits you will have a liability (copay, deductible, and coinsurance) from Mercy Medical Center for the facility charges and a separate bill for the physician portion. Facility charges for procedures at Mercy West and North Endoscopy are typically between $3,400 and $5,000 depending on the actual services provided. The portion of that amount that you are responsible for will vary depending upon your insurance benefits and the services provided. This does not include the financial responsibility you may have for the physician's bill.

If you have questions regarding the amount you will be billed under your current insurance plan, please contact your health insurance provider. If you have questions about your Mercy West or North Endoscopy bill, please contact Mercy Medical Center patient accounts department at 515-247-4199.

(515) 247-3121
1111 6th Avenue
Des Moines, Iowa 50314

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