Insurance & Billing

Insurance

Our practice participates in many health plans, though participation may change without notice. Each insurance carrier typically has many different plans so it is the insured’s responsibility to understand their benefits.

Insurances We Accept

Aetna
Aetna US Healthcare Inc.
Allways Health Partners
Blue Choice
Blue Cross Blue Shield
(except Anthem of NH)
Cigna
Fallon (select plans only)

Harvard Pilgrim Health Care
Healthcare Value Management
Healthsource
HMO Blue
Private Healthcare Systems
Tufts HMO
Unicare
United Healthcare

Insurances We do Not Accept

Allways Value HMO Select Plan
Cigna Local Plus
Fallon Wellforce ACO
Fallon Direct Care & Commonwealth Care
Harvard Pilgrim NH HMO ElevateHealth
Health Plans Inc. BMC Select Network

Humana (all non-choice care PPO products)
International Plans, such as Aetna or Cigna International
NH Medicaid, including AmeriHealth Caritas NH
Tufts Health Unify & Tufts Together MCO
Tufts Steward Plan

insurances We do not accept for new patients

TriCare

Billing

It is our office policy to expect payment at the time of service unless prior arrangements have been made. If your insurance company requires a co-payment, we require that to be paid at the time of your visit. As of March 1, 2022, we will no longer accept cash payments. Payments can be made via debit/credit (including MasterCard, Visa, Discover, and American Express) or check. We also offer discounts for services when the charges are paid in full at the time of the visit. Please note that this does not apply to co-payments or coinsurance when the remainder of the bill is paid by your health plan.

We are aware that unforeseen problems may arise and cause a family to encounter financial problems. Please call our Billing Department, Cornerstone, at 978-322-0778 if you have any questions or concerns about paying your bill.

5 Reasons Why You May Receive a Bill After a Well Child Visit

Making a Payment Online

Payments can be made through MyChart for patient or proxy accounts with billing access. Please note that only one proxy account may have this access, but please call the office if you feel you should have this billing access but do not.

To make a payment without this access, you may “Pay as Guest” using the “Make Payment” link below. You will need the account number on your statement but will not have access to past payments or balances.

For balances from Dates of Service before March 31, 2020, please call the office.

Make Payment

Right to Receive a Good Faith Estimate of Expected Charges for the Uninsured

nder the No Surprises Act, all health care providers are required to give uninsured patients (those who don’t have insurance or who are not using insurance) an estimate of the amount they will be billed for scheduled items or services or upon request for other non-emergency items or services.

You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the No Surprises Helpdesk at 1-800-985-3059.

Referrals

To improve our communication about your child’s care with other physicians, please call our Referral Department (781-933-0254) before your child sees a specialist. After the appointment has been scheduled, please call and be prepared to leave the following information on their voice mail:

child’s name & DOB
specialist’s name
appointment date and the reason for the appointment
insurance plan & ID number if you have a new plan
best daytime phone number to reach you

You may also enter your referral request on MyChart. Regardless of your insurance plan’s referral requirement, you should still contact the Referral Department so that they can send your child’s clinical history to the specialist prior to the appointment.

What is a referral?

A referral verifies that the PCP’s office has authorized the member’s care to that specialist. Because your PCP knows your history and health care needs, he/she is best qualified to help you decide whether or which specialist is needed. For example, the athletic trainer can “recommend” physical therapy, but the PCP needs to agree and approve the request.
Referrals are no longer required for Emergency Room visits, but please be aware that walk-in urgent care visits do require a referral and should only be used if our offices are closed or you obtain prior approval to do so.
It is the insured’s responsibility to understand their benefits and that a referral is not a guarantee of payment. Please make sure that the specialist we referred you to is contracted with your insurance.

Referrals vs. Recommendations

If your clinician provides you with a “referral” for a specialist, this should be considered a recommendation for a provider most suited to handle your child’s problem. An insurance referral should be considered an authorization for services in network and you must call our office to request a referral once you have scheduled the appointment. If your insurance plan does require referrals, it is essential that you call our Referral Department with the appointment details so that an authorization can be prepared and sent to your insurance company. We will also send relevant office notes to the specialist, which can be very helpful in providing your child’s history before his/her evaluation.

If you neglect to call for a referral authorization, you will be financially responsible for the cost of the specialist. It is your responsibility to understand your insurance benefits so you should familiarize yourself with your plan’s referral requirement.

Also be aware that many insurance companies do require authorization for visits to urgent care clinics. You should call our Referral Department on the following business day to alert us of your child’s visit & the need for referral authorization if your plan requires one.