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Insurance Issues: 1. Accepted Insurance 2. Emergency Approval 3. Billing Questions |
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Insurance Issues
Aetna
BXBS (all MA plans, some out of state plans)
Children's Medical Security Plan
Cigna Healthcare
Costcare
Fallon
GIC Indemnity Plan
Harvard Pilgrim
HCVM (Healthcare Value Management)
Healthsource (NH &MA)
Matthew Thornton
One Health Plan
Oxford
PHCS (Private Health Care Systems)
State John Hancock
Tufts HMO
Tufts Total Health
Unicare
United Health Care
If you believe you have an emergency you may go straight to the emergency room. As most can be more efficiently and effectively addressed over the telephone or nursing office hours. Feel free to call us with questions. But most Massachusetts law prevents insurers from requiring prior approval. A referral will be processed on the next business day.
Non-emergencies include upper respiratory infections (colds), earaches, sore throats, stomach aches, vomiting, diarrhea, constipation, rashes, and mild trauma.
3. Billing QuestionsBilling is a time consuming and costly procedure. We bill many insurance's directly. If you are uncertain of the insurance billing procedure, please call our billing line at (978) 256-5240, and we will be happy to help you.
If you are not insured or if services are not covered, payment at the time of the visit is appreciated. If payment cannot be made promptly, we greatly appreciate being informed as soon as possible.
HMO co-pays must be paid at the time of service, per your insurance contract. Please make sure you receive a receipt when services are paid at the time of the office visit. Monthly statements are itemized, and can be used for tax or insurance purposes. The statement contains all the necessary information for you insurer.
Prescription Refills
We will phone in prescription refills during office hours, as we need to have you child's chart available to check on proper dosages. Plan ahead so you don't run out of important medicines. Have your pharmacy name and number available.
Referrals
When referred to a specialist or hospital by one of our physicians, please request a referral from our office staff after making your appointment. Please be sure that the specialist is a provider in your insurance network, and have all the necessary information when you call:
- Child's name
- Date of birth
- Insurance ID# (including any member # or suffix)
- First & last name of the specialist
- Specialist's address
- Reason for referral
- Date of service
If you are referred to an Emergency Room during the weekend, or in the evening, please call the office for a referral on the following morning or Monday morning (whatever the case may be).