Financial Services Guide
Thank you for choosing New England Baptist Hospital (NEBH). Although finances may be the last thing on your mind right now, having an understanding of how the system works can make your visit to NEBH go more smoothly.
As a new patient at NEBH, you may want to contact your insurance provider for a written copy of your insurance policy. Having this information can help you make informed decisions about your care and assist us in getting the information we need to process your insurance claims quickly and accurately.
To avoid delays in handling your claims, please notify your doctor’s office or the NEBH registration office of any change in your insurance and/or demographic information.
You may be eligible for financial assistance. Please contact a NEBH financial counselor at 617-754-5979 for more information about the NEBH Financial Assistance Program or to complete an application.
Here are some things you should know regarding your health insurance upon visiting NEBH for the first time.
Primary and Secondary Insurance Coverage
Managed Care Plans
The Role of Your Primary Care Physician
Observation Status vs. Inpatient Status
Outpatient Radiology Procedures
NEBH Financial Counseling
Durable Medical Equipment
Preadmission Screening Visit and Rehabilitation Service
Understanding Your Bills
If you are covered by more than one insurance program, we will need information about both to coordinate your benefits. Remember to carry all of your insurance identification cards with you when coming for your healthcare visit.
Co-insurance is when your insurance company pays a percentage of your medical bills and you pay the other percentage. For example, your insurance may pay 80% and you would be responsible for the remaining 20%. If you are unsure if you have coinsurance, please contact your insurance company.
Managed care plans often require you to use specific physicians, facilities and/or ancillary services. They frequently require you to pay co-payments and obtain referrals from your Primary Care Physician before receiving healthcare services.
Some insurance plans have per visit co-payments, annual deductibles or lifetime or annual limits. Separate co-payments may be required for your doctor or professional services and for technical services such as laboratory tests, x-rays or MRIs. If any portion of your bill is payable at the time of service, come prepared to pay with cash, check or major credit card. Co-pays are expected to be paid at the time of service. For your convenience we accept MasterCard, VISA, and American Express. All costs not covered by your insurance company are your responsibility.
The PCP often plays an important role in managing your care. He or she may issue referrals and coordinate your care with your NEBH physician. Be sure to let your PCP know that you are coming to NEBH.
A referral is a specific direction or instruction from your PCP, which directs you to a participating provider for medically necessary care. A referral can be issued as a paper document or electronically. Most of the physicians at NEBH are considered specialists and may require a referral from your PCP. Some referrals allow for multiple visits, some for a single visit and others for a specified time period. Your insurance plan will have this information. You, as the patient, are responsible for obtaining referrals as required.
If your insurance plan is a Health Maintenance Organization (HMO), you are usually required to:
- Select and contact/visit your PCP to obtain written referrals for NEBH and NEBH physicians.
- Bring copies of your referrals when you come to NEBH for your appointment.
- Obtain referrals for all scheduled follow-up procedures and physician visits as necessary.
- Check with your insurance carrier to make sure you understand how to manage your referrals.
If you do not have the necessary referrals when you come for your appointment, your appointment may need to be rescheduled or you may be responsible to pay for your physician visit and/or any prescribed procedures.
Did you know that even if you stay in a hospital overnight, you might still be considered an “outpatient?”
“Observation Status” are hospital outpatient services provided to help the doctor decide if the patient needs to be admitted as an inpatient or can be discharged.
- Observation services may be provided while the patient is in a bed within the hospital until test results are reviewed by your physician; but the patient is still an outpatient.
The decision for inpatient hospital admission is a complex medical decision based on your doctor’s judgment and your need for medically necessary hospital care.
An inpatient admission is generally appropriate when you’re expected to need 2 or more midnights of medically necessary hospital care, but your doctor must order such admission and the hospital must formally admit you in order for you to become an inpatient.
Your hospital status (whether the hospital considers you an “inpatient” or “outpatient”) affects how much you pay for hospital services (like X-rays, drugs, and lab tests).
If you have Medicare, this may also affect whether Medicare will cover care you get in a skilled nursing facility (SNF) following your hospital stay.
Please consult the Observation vs. Inpatient guidelines of your insurance plan in which you participate.
As a Medicare beneficiary, you have certain guaranteed rights. These rights protect you when you receive healthcare, assure you access to needed healthcare services and protect you against unethical practices. Your rights include, but are not limited to:
- The right to information about what services are covered and how much you will have to pay.
- The right to information about all treatment options available to you.
- The right to appeal decisions to deny or limit payment for medical care.
The Centers for Medicare and Medicaid Services (CMS) requires healthcare providers to inform patients about their rights and responsibilities when their physician orders tests and procedures that may not be paid for by Medicare. Doctors recommend tests and procedures based on a wide range of factors including your personal medical history, any medications you might be taking and generally accepted medical practices.
While your doctor may find a test or procedure useful in order to provide you with the best care, it is possible that Medicare may not consider the service to be medically necessary. Medicare covers only those services which it has decided are reasonable and necessary for your treatment based on your diagnosis. If there is a chance that Medicare will deny coverage for a service ordered by your doctor, you will be given an Advance Beneficiary Notice (ABN) form to sign.
The purpose of an ABN is to give you advance notice that Medicare may not pay for the services you will receive. The ABN tells you which tests and procedures are not considered reasonable and necessary and informs you that you will be financially responsible for the services if Medicare declines payment. When an ABN is required, it will be explained to you and you will be asked to sign it before you receive the service.
You have two options when an ABN form is presented to you
- You may agree to be responsible for payment of services that Medicare does not consider reasonable and necessary and receive the services, OR
- You may refuse to be responsible for payment of services that Medicare will not cover and, therefore, not receive the tests or services.
Some procedures performed in radiology are considered surgical procedures and billed accordingly following the payor requirements. Dependent upon the insurance plan, a surgical co-pay may apply. These procedures may include but are not limited to: steroid injection, joint injection, and arthrogram. To verify please contact customer service with your insurance carrier.
If you are receiving hospital services, NEBH has a financial counselor who can provide guidance to you if you are underinsured or do not have insurance to cover your medical care. Please call 617-754-5974 or 617-754-5979 to speak with a financial counselor.
Please work directly with your physician’s office for guidance/estimates for all other care.
When you are discharged, your provider, in consultation with your physical and/or occupational therapists, may order or recommend the use of durable medical equipment (DME), such as crutches, canes, walkers, and commodes. You have the right to obtain supplies from any durable medical equipment provider. Please contact your insurer to confirm participating DME providers and coverage of DME. If you have any questions, please contact the NEBH DME Coordinator at617-754-5789.
Part of our clinical excellence and patient assessment process includes a physical therapy (PT) evaluation performed during Pre-Admission Screening. This is to assess your present mobility and will provide a base-line post-surgery to establish goals. Please understand your insurance carrier may indicate you have a copayment for that evaluation.
Your doctor and NEBH will bill your insurance company on your behalf. Your insurance company may send an Explanation of Benefits (EOB), which will explain a summary of charges and what amount (if any) you will be responsible for. This is an explanation, not a bill. If you are responsible for the balance, you will be billed by the hospital and/or your physician’s office.
You will receive a bill for hospital charges. All physicians bill separately from the hospital. This includes charges for consultants, pathologists, radiologists, anesthesiologists, attending physicians, hospitalists, surgeons, cardiologists, and durable medical equipment ordered by your physician.
Questions on a Bill?
If you have a question on a bill you have received, please look to see who the bill is from and call the following number:
New England Baptist Hospital
New England Baptist Radiologist
New England Baptist Medical Associates
Anesthesiology Associates of Massachusetts
New England Baptist Pathologist
Durable Medical Equipment (DME)
Please call your DME provider
Any questions regarding non New England Baptist Medical Associates should be directed to the physician’s office.