Billing

It is our office policy to expect payment at the time services are rendered unless prior arrangements have been made. If your health plan or 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.

All of our billing is done by computer. You will receive an itemized bill only once and subsequent bills will show only the balance due.  We are aware that unforeseen problems may arise and cause a family to encounter financial problems. Please feel free to discuss any problems with our billing department, which is located in our Woburn office (781-933-6219).

Making a Payment Online

Most payments can be made online via MyChart.  Because of our transition to a new computer system in March 2020, payments for dates of service on or prior to March 17, 2020 need to be paid via phone.  Please contact the billing department at 781-933-6219.

Cornerstone Coding & Compliance 978-322-0778

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  10/2013
  • Masshealth
    (including Boston Medical Center plan and MyCarePlan) 
  • TriCare

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

  • Allways Commercial ASO Boston Value HMO
  • 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.

Well Exams & Other Issues Addressed During A Well Visit June 2021

We wanted to take a moment to inform you that as of January 1, 2021, some changes have been made to the national guidelines for billing of medical office visits.  One change in particular that we wish to describe to you is how billing for routine checkups works under the new guidelines.  Under the new system, if we manage a medical problem during a checkup, we are required to document and charge for this service in addition to the usual charge for the checkup itself.

For example, if your child is found to have an ear infection during his or her routine checkup, there will be a billing charge for the diagnosis and management of the ear infection in addition to the usual charge for the checkup.  Or, if your child has asthma and we discuss how your child's asthma is doing and review the use of his/her asthma medications during a checkup, there will be a billing charge for the diagnosis and management of the asthma in addition to the usual charge for the checkup.  

While routine checkups generally do not involve co-pays or deductibles, you may be charged a copay or deductible when billing for a separate medical problem occurs during a routine checkup.  Whether you are charged a copay or deductible depends on the medical insurance plan you have and is determined by your insurance company, not by our office.

Please feel free to ask us any questions about these changes or contact our billing department about a bill you have received from our office.  

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 call the Referral Department so that they can send your child’s clinical history to the specialist prior to the appointment. Your call will ensure that the proper documentation has been sent, in addition to processing any necessary referrals.

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 March 2015

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.