PRIMARY AND SECONDARY INSURANCE COVERAGE
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 co-insurance, please contact your insurance company.
MANAGED CARE PLANS—HMO, PPO, OR POS
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 ROLE OF YOUR PRIMARY CARE PHYSICIAN (PCP)
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 electronically or as a paper document.
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.
OBSERVATION STATUS VS INPATIENT STATUS
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.
A patient under observation may remain in a bed within the hospital while test results are reviewed by a physician, while still being considered 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 two or more nights of medically necessary hospital care.
Your doctor must order 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 for your insurance plan.
OUTPATIENT RADIOLOGY PROCEDURES
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.
DURABLE MEDICAL EQUIPMENT
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 at 617-754-5789.
PREADMISSION SCREENING VISIT AND REHABILITATION SERVICE
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 to establish post-surgery goals.
Please understand your insurance carrier may indicate you have a co-payment for that evaluation.
UNDERSTANDING YOUR BILLS
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.