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Billing + Insurance

Understanding Your Insurance Benefits

Get Straightforward Facts about Your Insurance Benefits

There are many different types of health insurance and each insurance company may offer multiple different plans to hundreds of employers and their employees.  For this reason, it is very important that you understand the unique components of your plan and ask your health plan or employer what care and services they will cover and what they expect you to pay for directly.

The best way to reach your insurer is typically the member services number on your insurance card.

Here are some questions you should ask your health plan to help you understand your financial responsibilities:

Is a referral from my Primary Care Physician (PCP) needed to see other providers/specialists?
Please note that some health plans require you to work with your primary care office to obtain an insurance referral before seeing a specialist or other physician.

If you haven’t coordinated with your PCP first, some health plans will refuse to pay and expect you to cover the entire bill.

Will I owe a copayment for my health care services?
A copayment is a fixed dollar amount defined in your insurance policy that is your responsibility to pay.

Some plans vary the amount you pay based on the type of service you receive or where you receive the care.

For example: you may be charged $20 to see a primary care physician when you are sick but you may be charged nothing for an annual physical or a well baby visit or $40 to see a specialist provider at the same medical center.

Do I have a deductible?
A deductible is the amount you owe out of pocket before your insurance company will pay certain health care expenses.

For example: A health plan may say that you have to pay $1,000 of your medical care bills out of your own pocket before they will cover any of the cost of your medical care.

Is there coinsurance associated with my plan?
Coinsurance is the percentage of the total bill for medical services that some insurance plans require the patient to pay even after the deductible is met.

For example: After you meet your $1,000 deductible, your insurance may cover 80% of your medical bills and expect you to pay for the remaining 20%.

Are Tufts Medical Center and their doctors’ part of my plan’s network?
Some health plans require a hospital to be part of their network in order to cover medical expenses.

Your plan may allow you to be seen outside of the plan’s network, but at a higher cost to you.

Please confirm with your health plan that Tufts Medical Center and its physicians are part of your plan’s network or that we can be seen as an out of network provider.

Billing Information

Billing at Tufts Medical Center + Floating Hospital for Children

Following your care at Tufts Medical Center, we will send a claim to your health plan for services received.

Once the health plan has provided payment for its portion, you will receive a bill for any remaining balance the insurer tells us is your responsibility such as deductibles, copayments, coinsurance or non-covered services.

When a patient sees one of our physicians on the Boston campus, the charges will be separated into two bills: one from your physician and one from Tufts Medical Center.

The bill from your physician (Tufts Medical Center Physicians Organization) covers his/her professional services.

The bill from Tufts Medical Center for services on the Boston campus generally includes diagnostic testing and lab services as well as a facility fee covering supplies, staff and overhead for the office visit.

Academic medical center’s with physician offices on site charge this facility fee because they are required to meet additional regulatory requirements that a physician’s office outside of a hospital does not have to meet.

Many insurance companies cover the facility fee; however, your insurance may require you to pay some or all of this charge.

Quick Tips to Ensure a Smooth Billing Process

Should I speak with my insurance company to understand my benefits?
Yes, it is always a good idea to discuss the type of coverage you have and the way your insurance company covers the cost of the health care services you receive.

The best way to reach your insurer is typically the number on the back of your member card.

My personal information has changed (such as address, insurance provider, etc.).  How do I change this with the hospital?
Please contact us.  We’re here to help make important updates to your account.

617-636-0084
Monday to Friday
7:30 am to 5:00 pm

If I need financial assistance, what can I do?
Please call our Financial Coordinators.  We’re happy to discuss your options.

617-636-6013
Monday to Friday
7:30 am to midnight

What will I owe for a visit?
Depending on your health plan, you may owe a copayment, deductible or coinsurance. What you owe will depend on the types of services you receive and what is covered under your specific plan.

Your financial responsibility for being seen at one of Tufts Medical Center’s hospital-based practices may differ compared to a community practice.  In addition, some services performed in the exam room (scopes, biopsies, etc.) are considered surgical procedures by your health plan and may result in higher out of pocket costs.

We urge you to contact your health plan to understand what you will be responsible for paying for your healthcare services.

Registration Information

Registration at Tufts Medical Center + Floating Hospital for Children

When you schedule your first appointment with us, we gather your insurance information, mailing address and other key contact information so we can contact you and also work with your insurance company to coordinate payment for your medical care.

If at any time after this you need to update your information, please contact us.

617-636-0084
Monday to Friday
7:30 am to 5:00 pm

Financial Assistance

Financial Assistance at Tufts Medical Center + Floating Hospital for Children

We have Financial Coordinators available to assist you if you do not have insurance coverage or if you do not have enough coverage and are having difficulty paying your bills.

Tufts Medical Center Financial Coordinators can help you by:

  • Reviewing eligibility criteria with you to see if you qualify for any assistance programs such as Medicaid or Medicare
  • Assisting you with the application process to obtain Medicaid and/or disability services
  • Working with you to arrange a payment schedule for paying your balance

Our coordinators are available at 617-636-6013 Monday-Friday from 7:30 am to midnight.