Insurance and Billing
We will bill most insurance carriers for you if proper information is provided to us. Co-payments and deductibles are due at the time of service . Any care not paid for by your existing insurance plan will require payment in full upon notice of insurance claim denial. All MassHealth patients must be enrolled with the Tufts Health Together through Boston Children’s ACO. A valid MassHealth/Tufts Health Together card must be presented at each visit to verify eligibility.
Your insurance (particularly PPO plans) may exclude, or limit, certain services like labs and screening, based upon the benefit levels chosen by your employer. You should carefully review your benefit description for details.
Some insurances may deny benefits and you will be responsible for the entire bill. Our billing department can help set up payment arrangements if needed. If your account balance is 90 days past the due date and is not on a signed payment plan, your account will be turned over to our collection agency.
Any returned checks are subject to a $50.00 fee.
PNW providers continue to be available to see patients via telehealth. Please note that telehealth visits can be done as an audio-only telephone encounter or through a video encounter using a secure HIPAA compliant platform. In order to allow for an adequate discussion, both types of telehealth visits will be scheduled in your provider’s schedule and then documented similar to an in office visit. We bill your insurer in the same manner as an in person visit. Coverage for telehealth has expanded over the past year. In most cases your insurer will provide coverage for telehealth encounters in the same way as in person visits. Therefore, depending on your specific insurance plan, telehealth visits may generate a charge to your deductible or a co-pay. If you are unsure about the specifics of your coverage for these visits, please contact your insurers. Our billers are also available to answer any questions they can. We are grateful to have telehealth as an option to provide continuity of care for our patients.
Referral and Prior Authorization Network
If we determine that your child needs to see a sub-specialist, we will refer you to the appropriate physician. In many cases a written clearance from our office is required in advanced. Though some insurance carriers do not require a referral, it is your responsibility to understand your plan requirements. To request a referral please fill out this referral request form . This should be done after you have a scheduled appointment with the specialist.
We are happy to assist in any prior authorization needed for specialty services or medications. Prior authorizations can take up to 7 business days to process.
If you need a refill for a medication please visit your MyChart account and click refill under the child who needs it. One of our nurses may reach out. While most refills are sent within the day of request, please allow up to 3 days and plan accordingly. Please follow up with your pharmacy after the inital request.
If an ADHD medication needs to be refilled please call our office and leave the request on the dedicated line. Please allow 5-7 business days to have it completed.
Missed Appointments/ No Shows
Quality care for our patients is priority and in an effort to serve you better, we ask for proper notice for all cancellations. Cancellations less than 24 hour notice will be charged $50.00 for missed office visit appointment. Any behavioral health appointment no show will be charged $75.00 if 24 hour notice is not given.
*Please remember confirmation calls are a courtesy and ultimately it is your responsibility to know your appointment date and time.