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Insurance & Claims

Knowing your insurance's rules can help you plan accordingly.  

In Network Insurance Status

We continuously evaluate our contracts with insurance carriers to provide you with the best in-network options and we participate with most major insurance plans including (but not limited to):

  • Blue Cross Blue Shield
  • Health New England
  • Medicare
  • Most Medicaid (Mass Health) products
  • Tufts
  • Cigna
  • Aetna
  • United Healthcare
  • Connecticare
  • Harvard Pilgrim
  • John Alden
  • Private Healthcare Systems
  • Fallon: Select Plan and Commercial PPO (see below for other Fallon plans)
  • First Health
  • Multiplan

Insurance plans we DO NOT accept at this time are listed below. This is not a comprehensive list but rather a guide that is subject to change without notice.  

  • Certain Mass Health products: Limited, HSN, or partial HSN, BMC Healthnet, Mass Health buy in
  • Neighborhood Health Plan
  • Caremark/Healthnet HMO
  • Fallon: Direct Care, Commonwealth Choice

We recommend checking with your insurance carrier regarding in-network providers. (For your convenience it is common for a phone number to be listed on the back of the insurance card.)

Get to Know your Coverage

Knowing your coverage will help you avoid unanticipated bills and frustration. Some things you should verify include:

  • Copayment (this amount can be different based on the service you are seeking.)
  • Patient deductible
  • Coverage for well-woman exams (how often they will be covered, etc.)
  • Requirements for referrals
  • Pre-existing clauses (ie, coverage rules for a pre-existing condition)
  • Prescription benefits
  • Laboratory coverage (for example, some insurance companies will pay for services performed only at certain laboratories). We’ll need to know this at your visit so we can arrange to send your specimens to the correct facility.
  • Covered and non-covered services

Claim processing

One of our five billing specialists will handle your claim from start to finish. Among them, they have over 55 years of experience in ob/gyn billing and are highly effective in their communications with insurance companies to insure proper payment of your claim.

Shortly after you receive a service from our practice, we will send a medical claim to your insurance carrier. Once your claim has been processed, we receive an explanation of benefits (EOB) from your carrier that reports the payment made as well as any balance due from you. We review the EOB for accuracy and process the claim appropriately in our system. If your insurance company reports that a patient balance is due and you have not already paid that balance, we will send you a statement. 
 

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