Insurance Information

HEALTH INSURANCE

Health insurance can be confusing.  As a policy holder and a patient it is important that you understand your insurance plan , your coverage and what your insurance plan requires to process a claim.  A starting point is to understand these terms.   Premium is the monthly fee for your insurance.  Deductible is how much you pay before your insurer pays.  Co-insurance is the percentage you must pay for your medical care.  Co-pay is your cost due at the time of a medical service.  Referral comes from your PCP when referred to a specialist.  Some insurance companies require a documented referral number that your PCP must request and forwarded to the specialist. Authorization is when an insurance company requires the performing physician to call the insurance company with information on the scheduled procedure and the medical reason for it.  The insurance company then determines whether or not it will approve the procedure.  If approved an authorization number if given, if denied the insurance company will not cover the cost of the procedure.

 

We urge patients to carefully read over their policy and know its specifics.  Some insurances make a distinction between tests ordered for screening purposes (i.e. a patient doesn’t have any symptoms) and a test ordered for diagnostic purposes (i.e. a patient has symptoms).   Some insurance require testing to be done at specific facilities or type of facility (i.e. hospital, clinic or free standing ambulatory center).  It is impossible for our office staff to know the details of every patient’s insurance plan.   If there are any questions regarding coverage for a particular medical procedure or medication it is imperative that patients contact their customer service representative (the telephone number is listed on the back of your insurance card) and ask specific questions. If there are coverage issues concerning a scheduled appointment, please contact our office.  Once a service claim has been submitted by this office and processed by an insurance company, resubmittals and/or appeals are difficult, lengthy and in the end may not reverse an initial decision.

 

Patients who know their insurance policy are better equipped to make medical care decisions and also know in advance what if any balances will be shifted from the insurance company and billed directly to them.

The office accepts most insurance plans. Please check with your particular insurance company that Dr Curran is a providing network physician.

Please make sure you bring all your insurance cards to the office and to the hospital for your visits. Let us know when there is any change to your insurance information. As the insured you are responsible for knowing and understanding your insurance policy coverage for consultations, office visits and outpatient procedure with Dr Curran.

If your insurance company requires a primary care physician referral, you must make sure you have an active referral to Dr Curran on file before your visits and or procedures. In accordance to insurance policy, without an active referral you will be asked to sign an insurance waiver of payment before your visit.

If your insurance company requires prior authorization before a particular procedure, X-ray or image study that Dr Curran has recommended, make sure an active authorization is on file prior to your procedure, X-ray or image study.

****If you have a United Health Plan you may require an insurance authorization for your colonoscopy.  Call the customer service number on your health card , tell the representative you are having a colonoscopy which will be billed using CPT code 45378 or 45380 or 45385 (depending upon findings at the time of your colonoscopy) and ask if your policy requires a prior authorization.  Please then contact Doreen with this information as your appointment will need documentation that no authorization is required or Doreen will need to contact your insurance for the authorization number that will be submitted on the colonoscopy claim for payment processing.****

 

In accordance to insurance policy, copays are payable at the time of your office visit. The office accepts cash, checks or credit cards.

This office billing department submits Medicare secondary claims to most major insurance companies. For all other insurances, you will be sent a statement for your Medicare balance. You should know your secondary insurance benefits for consultations, office visits and outpatient procedure with Dr Curran. You can contact your secondary insurance for instructions on how to submit for your reimbursement. .

Statements of account are mailed monthly. Payment is expected within 10 days of receipt. Monthly payment contracts can be arranged. Inactive balances beyond 60 days are subject to collection.

Questions on insurance denials, deductibles or patient balances indicated on your statement should be directed to your insurance company.

Statements from this office are separate from Marlborough Hospital, Charles River Endoscopy Center and Anesthesia billing.  Questions should be directed to the phone numbers  listed on those statements.