- Make sure you have your current insurance card with you at all times.
- Be familiar with your insurance benefits. It is the patient’s responsibility to know the insurance carrier’s requirements and procedures.
- Make sure our physician is listed as a participating provider in your plan’s provider book.
- If your insurance carrier requires a referral authorization, contact your primary care physician prior to seeing a specialist.
- Be aware that most referral authorizations are good for a certain number of visits and have an expiration date. Please make sure your primary care physician gives enough visits to our practice. It is your responsibility to contact your primary care physician prior to your appointment to obtain the referral information.
Usual and Customary Rates
Your insurance carrier may claim that your bill exceeds the usual and customary rates for a specific type of service. Please understand there are no usual and customary rates. Each insurance company determines how much it will reimburse for different medical services, and those rates vary widely.
Most managed care insurance companies, Health Maintenance Organizations (HMOs) or Point of Service plans (POS) require a referral or authorization from your primary care physician for you to see a specialist. It is your responsibility to be familiar with your insurance coverage and know whether or not your insurance carrier requires you to have a referral authorization. If your insurance carrier does require a referral authorization from your primary care physician, please let your primary care physician know. If your insurance carrier requires a primary care physician referral and one was not obtained, you will be responsible for payment of services rendered.
Associates in Otolaryngology will submit a claim for you to any third party or insurance carrier. Any fees not payable by the third party or insurance carrier are the patient’s responsibility. If you prefer to file your own claim, we will provide you with all of the necessary information. In this case, you will need to pay for your services in full at the time they are rendered.
It is the patient’s responsibility to understand their co-insurance, deductible and authorization policies. Many insurance plans require an additional co-insurance for surgical procedures. Our office will bill your insurance company for professional fees only. Professional fees are the charges for the physician services only. All hospital and anesthesia fees are billed separately from our practice.
All co-payments, deductibles and payments for non-covered surgical procedures are due prior to your surgery. Prior authorization may be required by your carrier.
Commercial Insurance Carrier
Associates in Otolaryngology accepts most major health insurance plans, including:
- Blue Cross Blue Shield
- Harvard Pilgrim
- United Healthcare
Managed Care Insurance Carrier
If you are covered by a managed care company, we will collect co-pays and deductibles at the time of service.
Federal and State Government Programs (Medicare, MassHealth)
We are Medicare providers and do accept assignment from Medicare. All MassHealth and Network Health patients must show a valid card each time before being seen by doctor. We will verify eligibility for MassHealth prior to your appointment. Whenever possible, Associates in Otolaryngology will submit claims to your secondary insurance carrier as well.
Commonwealth Care Health Insurance Program
his program connects eligible Massachusetts residents with approved health plans and helps them pay for them. It is an insurance program for uninsured individuals with incomes that fall within certain guidelines and who meet other qualifications. With Commonwealth Care, you choose a health plan and you choose your own doctor. To find out more about this program, please call customer service at 1-877-MA-ENROLL or go towww.mahealthconnector.org.