About Your Bill
Thank you for selecting Massachusetts Eye and Ear and our physicians for your health care. This document provides you with information about our registration process and financial issues associated with your care.
Insurance coverage and financial responsibility, including copayments, may differ for services provided in an outpatient facility than for services provided in a physician office setting. Please contact your insurance company to fully understand your coverage for services provided in a hospital outpatient facility.
Physician Office and Hospital Outpatient Billing at Partners HealthCare:
Physician Office Billing
When your visit takes place in a physician office, you will usually be charged only for the physician’s examination, and your co-payment will usually be your only out-of-pocket cost.
We will request your co-payment when you check in for a visit.
Hospital Outpatient Billing
When your visit takes place in a hospital outpatient location, there will typically be two charges which may result in you paying more for your visit than if you are seen in a physician office. Your out-of-pocket costs could include the following:
- You will be charged for the physician’s examination, which will usually be covered by your co-payment.
- You will also be charged by the hospital for use of hospital space, equipment, and support staff. This is commonly known as a “Facility Fee.” Your health plan may apply these hospital charges to your annual deductible, and after using up your deductible, you may be responsible for a co-insurance payment.
You may receive a bill that combines the charges from the hospital and the physician on one line or these charges may be split into two lines, depending on the location. We will request your co-payment when you check in for your visit, and we will send you a bill for any unpaid balances after we receive payment from your insurance company.
Understanding Whether My Visit is a Physician Office Visit or a Hospital Outpatient Visit
You can find information about whether your visit is a physician office or hospital outpatient visit in notices in our waiting rooms, on the websites of our hospitals and physician groups, and in electronic appointment reminders for your scheduled visits.
Referral and Prior Authorization
For both physician office and hospital outpatient visits, your health insurer may require you to get a referral or authorization. In addition, our providers may be considered “In Network” or “Out of Network” depending on the specifics of your health insurance plan, which could affect the amount you pay.
Billing for Procedures Performed During the Visit
No matter the location, if a procedure is performed during the visit, you may have further out-of-pocket costs for additional physicians’ services and for use of the hospital facilities and staff, even if the procedure was performed in the same exam room as the visit with the physician. Your health plan may apply these additional physician and hospital charges to your annual deductible, and after using up your deductible, you may be responsible for an additional co-insurance payment.
Laboratory and Imaging Services
If your physician ordered laboratory tests or imaging services (such as X-ray, CT or MRI), you may be billed for these tests by the hospital, clinical laboratory, or imaging center, and you may also be billed for the services of the physicians (usually pathologists and radiologists) who interpreted the test results.
Understanding How Much My Visit Will Cost
It is your right to receive an estimate of the cost of your visit in advance of the visit. Please contact Partners Patient Billing Solutions (see below) at least two business days prior to your visit to get an estimate. Please have as many details as possible about the upcoming visit, including the provider name, location, and details of the planned service or procedure.
Special Notice for Medicare Patients
If you are a Medicare beneficiary and your visit takes place in a hospital outpatient location, you will be responsible for a Medicare Part B out-of-pocket co-insurance payment of approximately $25 for the hospital facility charge. Procedure charges or other testing could increase your out-of-pocket expense.
Please contact the Member Services department of your health insurance plan to verify your coverage and financial responsibility for services described on this page. This phone number is usually located on your insurance card.
If Your Insurance Company Does Not Answer all of Your Questions, Please Contact Partners Patient Billing Solutions:
Patient Billing Solutions
399 Revolution Drive, Suite 410
Somerville, MA 02145–1462
Monday–Friday, 8:00 AM to 4:30 PM
Learn more about Mass. Eye and Ear Physician Office and Hospital Outpatient Locations.
Before Your Appointment:
We recommend checking with your insurance company to ensure that they will pay both Mass. Eye and Ear and the physician for your services, and to understand what your copayment, deductible, and coinsurance costs may be.
If your insurance plan, including Medicare Advantage Plans and Medicaid Managed Care Plans, is not contracted with Mass. Eye and Ear or if Mass. Eye and Ear or your physician are considered “out-of-network” by the plan, your costs may be higher.
If your insurance requires a referral from your Primary Care Physician and it is not in place prior to your appointment, your appointment may need to be rescheduled or you may be asked to sign a payment responsibility waiver when you arrive.
If you are coming in for service that is not covered by your insurance plan, payment is expected prior to, or on, the date of service. If you do not have insurance or are in need of financial assistance, please contact one of our Financial Coordinators prior to your appointment.
Worker’s Compensation or Other Accident:
Coverage for these services requires verification. Please bring all documentation related to your case on the day of your appointment.
When You Arrive for Your Services:
Please let us know if your personal information or insurance coverage has changed since we last spoke with you.
Collection of copayments is required by your insurance plan. We collect known copayments at the time of service, but because we do not always know all the services you will be receiving, additional copayments may apply. In accordance with your insurance plan, you will be billed for these at a later time.
If You Need Medically Necessary Surgery or Treatment:
If you have health insurance, then your health plan may require pre-authorization for services. We will contact the plan or your primary care physician to obtain these pre-authorizations.
Since benefit levels vary by plan, it is recommended that you call your health plan to confirm that your surgery will be covered and determine what your out-of-pocket expenses may be.
If you do not have health insurance, then you will be given a good faith estimate and access to a Financial Coordinator who can assist you in determining how your surgery may be covered.
If You Choose to Have Non-Medically Necessary Surgery or Treatment and You Do Not Have Insurance:
You will be given a good faith estimate and will be required to pay in full prior to receiving services. You should ask to meet with a Financial Coordinator if you think you will need financial assistance.
You are financially responsible for any deductible and/or coinsurance payments imposed by your insurer, and for any services not covered by insurance.
If you do not have insurance or are unable to pay the full amount at the time of service, our Financial Coordinators will work with you to see if you are eligible for any other coverage, or to establish a payment plan.
Mass. Eye and Ear and our physicians accept the following forms of payment for services: check, money order, and all major credit cards. Wire transfers are also accepted.
You can view all of your bills online.
Important Phone Numbers:
- Pre-Registration: 617-573-4200
- Financial Coordinators: 617-573-5664
- Billing: 617-573-3135
Massachusetts Eye and Ear complies with applicable Federal and State civil rights laws and does not discriminate on the basis of race, color, national origin, citizenship, alienage, religion, creed, sex, sexual orientation, gender identity, age or disability. Massachusetts Eye and Ear does not exclude people or treat them differently because of race, color, national origin, citizenship, alienage, religion, creed, sex, sexual orientation, gender identity, age or disability.