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 that cover the Western Massachusetts area.  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 and out of pocket costs 
• 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

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. If your insurance company reports that a patient balance is due and you have not already paid that balance, you will receive notification from our practice regarding the balance due. 

It is very important that we are able to submit your claim to your insurance company with accurate demographic information.  If the demographic information that is on file with your insurance company is different than the information we have in your medical record, it may cause your claims to be denied resulting in a balance due.