Helpful Reminders for Your Care Decisions

Last year, Human Resources shared updates regarding changes in how certain Mercy services are billed, including clinic-to-hospital outpatient department (HOD) transitions and how those billing structures may be reflected in patient statements.

As a helpful reminder, we want to revisit two previous communications that continue to be relevant as these billing processes are still in place:

• Mercy Clinic Billing Changes and Hospital Outpatient Department Transitions (June 2, 2025)
• Mercy: Your Financial Responsibility for Outpatient Elective Care (June 24, 2025)

These resources provide important context for understanding how provider-based billing may be applied to certain services.

A helpful overview of what this means

As outlined in the earlier posts, some Mercy locations and specialty services are now billed under a Hospital Outpatient Department (HOD) structure. In many cases, the care experience remains the same, while the billing methodology reflects how the service is classified.

In general terms, this may mean:

• Services are billed as hospital outpatient rather than traditional clinic visits
• Claims may include both professional and facility components
• Cost-sharing may apply differently depending on how the service is billed (deductible, coinsurance, vs specialty office visit copay)
• Some visits that were previously subject to a flat copay may now be processed under facility-based billing rules

These updates are based on provider billing structure and do not reflect changes to the Mo State medical plan design or covered benefits.

Reminder: Planning ahead for outpatient elective care

As shared in the June 24, 2025 post, outpatient elective services delivered in a hospital outpatient setting are processed differently than services provided in a standard clinic setting.

This can sometimes result in:

• Two separate billing components (facility and provider services)
• Costs applying to deductible and coinsurance instead of a single copay
• Differences in out-of-pocket responsibility depending on site of service

To support informed decision-making, employees are encouraged to:

• Verify whether services are scheduled in a clinic or hospital outpatient setting
• Review benefits ahead of scheduled care when possible
• Request cost estimates from Mercy

What remains the same

It’s important to note:

• The Mo State medical plan design has not changed
• Employees continue to have access to Mercy providers and facilities
• Preventive care and covered services remain available under plan provisions

These updates are focused on billing structure and transparency in how services are processed.

Questions or support

If you have questions about a bill or how a service was processed, helpful next steps include:

• Reviewing your Explanation of Benefits (EOB)
• Contacting Mercy Billing Customer Service
• Reaching out to Point C for coverage questions

Closing reminder

Healthcare billing can vary depending on where and how services are provided. Staying informed about these structures can help support smoother planning and clearer expectations when scheduling care.

We encourage employees to revisit the two linked HR blog posts above for additional detail and examples.