In hospital-based outpatient clinics, Medicare and Medicaid patients could receive two (2) separate bills for services provided in the clinic – one from the doctor and one from the hospital. Adult Medicaid patients who have a spend down agreement will be required to pay for the clinic visit – and the facility fee — until they have met their pre-determined spend down amount thru Medicaid. For patients covered by Medicare or Medicare Advantage plans, non-physician charges billed by the hospital will be subject to coinsurance.