Insurance & Billing

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. For your convenience, we accept MasterCard, Visa, Discover, and American Express. 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 the Billing Department, Cornerstone, at 978-322-0778 if you have any questions or concerns about paying your bill.

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.

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.

Our practice participates in most health plans
with the following insurance companies:

  • 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 

We do not accept any new patients with:

  • NH Medicaid  
  • Masshealth (including Boston Medical Center plan and MyCarePlan) 
  • TriCare

Please note that we are not contracted with
& do not accept:

  • Cigna Local Plus
  • Fallon Wellforce ACO
  • Fallon Direct Care & Commonwealth Care
  • Humana (all non-choice care PPO products)
  • International Plans, such as Aetna or Cigna International
  • Tufts Health Unify & Tufts Together MCO
  • Tufts Select Spirit and Steward Plan

Our team will verify your health insurance eligibility prior to or at check in for each appointment.  Please bring your insurance card to every appointment so that we can be sure we have the most recent card on file.  If your insurance plan changes, please notify us as soon as possible.  You can submit new insurance information by calling our office or uploading the new information and a picture of your insurance card via MyChart.

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.