Insurances/Financial Policy

Insurances

MVPediatrics is contracted with most major commercial insurance companies. There are many different plans offered through each company, so be sure to contact your insurer directly to verify that we are “in-network” with your specific plan. If your plan is an HMO/EPO or requires a PCP on file, contact your insurer to select one of our Physicians as your child’s Primary Care Provider (PCP) before your appointment to avoid any processing delays.

MVPediatrics Financial Policy

Thank you for choosing MVPediatrics. Our goal is personal and efficient care.  We rely on your collaboration.

Patients must complete our New Patient Packet before being seen in our office for the first time. Please verify that our providers are contracted with your specific health insurance plan.  Since contracts can change frequently the best way to verify this information is to call your insurer directly.

Please call us prior to your next appointment if there are any changes to your insurance plan or medical coverage so we can verify that the insurance company has your children’s information and Primary Care Provider (PCP) listed correctly. This information includes: name spelling, date of birth, PCP, etc. You are responsible for payment if this information is not correct.

Please bring your insurance card to your first appointment. If you have an insurance-required co-payment it is due at the time of your child’s visit. We accept MasterCard, Visa, HSA and flex spending cards, in addition to cash or checks. Your insurance coverage is a contract between you and your insurance company. Please review your policy so that you are aware of your benefits and obligations. If there are any additional out-of-pocket costs associated with your visit, we will mail a statement to the address we have on file once we receive the explanation of benefits from your insurer after they’ve processed the claim. Please make sure we have the correct mailing address on file for your child so that you receive any statements in a timely manner.

Insurance disputes should be addressed directly with your insurance provider as soon as you become aware of them. Your insurance company has strict timelines for resolution of claims. If you have questions or if you require a payment plan please call our billing coordinator immediately. Balances in dispute must be paid and we will issue you a credit/refund if your insurance company reprocesses a claim for you. If a balance goes unaddressed for 90 days it may be eligible for collections. We hope we never have to get to that point. We are more than willing to work with you.

Please be aware of the following:

No show visits will incur a $50.00 fee with the exception of emergency situations or documented illness.

Some insurances require a “coordination of benefits” verification from time to time. This request is typically to verify the primary insurance policy or other pertinent information on your policy.  Please respond promptly to your insurance company’s request for this information so that they may process your claim in a timely fashion.

Most plans have a patient cost share such as a copay, co-insurance, deductible, or combination. Some deductibles only apply to certain services which may include: in-office tests, blood work, screenings, wart removal, nebulizer treatments, or other procedures performed in-office. We are happy to supply you with the CPT billing codes for any requested service so you may contact your insurer to find out if there will be any out-of-pocket costs associated with them.

Preventative wellness visits are almost always covered 100%. These routine visits are age-based as follows: 1st Newborn visit, 1, 2, 4, 6, 9, 12, 15, and 18 months of age, then annually starting at age 2. Some insurances will also cover a 2.5 year well visit – please contact your plan directly to ensure coverage. Visits outside of these anticipated wellness visits are considered an “evaluation and management” visit per your insurance provider and may have out-of-pocket costs.

It is not uncommon for patients in the course of a routine wellness visit to receive evaluation and management service for a separate and specific problem, as well as routine/preventative services. For example, your child is seen for a routine visit and the doctor discovers an ear infection or your child has behavioral issues that require care coordination. Both services must be reported to the insurance company and may result in an additional co-payment or charge per your insurance contract.

If you need financial assistance with your bills please contact our billing coordinator, Marissa Gurney. She can help you establish a payment plan and provide guidance as needed in regards to health insurance/medical bills. Marissa can be reached at 617-845-0586 or emailed: mgurney@gotomvpeds.com.

For Patients with MassHealth: Please select the “Mass General Brigham ACO” policy, as that is the ONLY MassHealth network with which we are associated. If your child is enrolled in the Children’s Medical Security Plan, please confirm that their Primary coverage is through that plan as Mass Health will not pay for claims as a secondary insurance unless the Primary insurance has first paid the claim, per their regulations.

Some companies with which we are NOT currently contracted*:

Tufts Direct, Tufts Spirit, Harvard Pilgrim BIDMC Select, Fallon (Please call your plan; we are contracted with some Fallon Plans, but not all), Celticare, Health New England, Minuteman Health, Coventry, Guardian Health, HMO Blue Select, Cigna – Local Plus, BMC Healthnet Plan.  This is not by our choice.

*This list is subject to change; please contact your plan directly to verify coverage.

We will work with you and continue to care for your children if you lose your insurance.

Please see our Forms page for the downloadable Financial Policy.