Billing & Insurance

Your insurance plan determines your co-pay amount and they require that we collect your designated co-payment at the time of service. Please be prepared to pay the co-payment at each visit. We accept all major credit cards, check, Apple Pay, Google pay, and CareCredit. We no longer accept cash payment in our offices as of 1/1/2023. If you are unable to pay your co-payment at the time of your visit, you will be charged a $15.00 administrative fee. Failure to pay co-payments upon check-in may result in non-emergent appointments being rescheduled.

If you are a member of an HMO, it is mandatory that you get a referral from your Primary Care Physician to see a specialist, have injections/procedures, and have x-rays. Your insurance company will not pay for the visit without a referral. Please call your primary care physician in advance to ask for a referral. If possible, try to get a referral for multiple visits so you do not have to repeat this process every time you come to the office. If a referral has not been obtained and the claim is denied, you will be responsible for payment in full. If you do not have a referral at the time of your visit, you will be required to put a card on file. If the required referral is still not received, you will then be responsible for payment and the credit on file will be charged.

Your health insurance policy is a contract between you and your Health Insurance Company or employer. It is important for you to be an informed consumer, who understands the specifications of your insurance policy (e.g., doctor visit coverage, referral/authorization requirements, radiographs, durable medical equipment, etc). If you are uncertain about your current health insurance policy benefits you should contact your plan to learn the details about your benefits, out-of-pocket fees and coverage limits. Our doctors belong to many insurance plans. Before your appointment, please be sure your doctor is in-network and the services are covered under your plan. If your doctor is out-of-network, you will be billed for the cost of care. As a courtesy to you, we will bill your insurance company directly for medical service rendered. If problems arise regarding coverage issues, we will attempt to work with your insurance company to help resolve them prior to making it your responsibility. However, please be advised that you are ultimately financially responsible for payment of medical services rendered by this office. If we receive payment at a later date, you will be reimbursed. If we contact your insurance carrier regarding benefits or authorization on your behalf, we are not responsible for inaccurate information provided to us by your carrier. The information about your plan that we relay to you is in good faith.

We expect that each charge will be paid in full the first time it is presented to you. Once your insurance carrier processes your claim, we will bill you for any remaining patient responsibility deemed by your insurance carrier. For the most up to date balance information, please check your patient portal account regularly. Past due amounts may hinder your ability to have appointments scheduled and could result in possible dismissal from the practice. If you cannot pay in full we request that you contact our Billing Department to arrange an acceptable payment plan. Any balance over 90 days, without prior arrangements, may be sent to our collection agency and will be charged a $25.00 fee. If you have a documented financial hardship, please contact our Billing Department. Please note financial hardship consideration is on a case-by-case basis and written documentation from the patient (e.g., W-2 withholding statements, pay stubs, income tax return) must be received for consideration. In every effort to assist you with meeting your obligations, we offer many payment options. We accept all major credit cards, we offer card on file agreements which can easily be done at check-in, auto-withdrawal payment plans for checking account or credit card, and CareCredit.

Failure to give 24 hours cancellation notice or failure to keep your scheduled appointment may result in a charge of $50. Missed appointments represent a cost to us, to you, and to other patients who could have been seen in the time set aside for you. We reserve the right to charge a fee for canceled or missed appointments. If you must cancel an appointment, we require a minimum of 24 hours notice. Repeated missed appointments and/or cancelling with less than 24 hours notice may hinder your ability to have appointments scheduled and could result in possible dismissal from the practice.

There is a $150 surgical scheduling fee to hold your surgical date. This fee must be received before securing your surgery date. Once your surgical claim processes with your insurance, if the surgical scheduling fee exceeds the amount you owe for the surgery, you may be eligible for a refund as long as there are no outstanding balances on your account. The surgical scheduling fee will be applied towards any outstanding patient responsibility on your account before being refunded. Failure to give less than a 15 business day cancellation notice or failure to keep your scheduled surgical date may result in the $150 being forfeited.

If your treatment includes a surgery/procedure, we will obtain a prior authorization for the surgery/procedure with your insurance carrier. We will also verify your insurance benefits and obtain your coinsurance and/or deductible. Using this information, we will estimate your out-of-pocket portion of those charges for our services. The estimated amount will be reviewed with you before surgery is scheduled. A pre-payment request will be made at that time. Actual services and your final out-of-pocket cost obligation may vary from the estimates. Financing may be available through CareCredit. For more information, contact our Billing Department.

Charges for services incurred as a result of a verified work-related injury will be treated as worker’s compensation, and we will bill the workers’ compensation carrier as a courtesy to you. You must provide us your date of injury, claim number, and case manager’s name and telephone number before making an appointment. If you make an appointment using your private health insurance and inform us at the time of the appointment that it is workers comp, we reserve the right to cancel your appointment until the claim can be verified. If your claim is denied, we will bill your regular medical insurance carrier. When the claim is no longer pending and any portion of your claim is ultimately resolved against you by workers’ compensation and your medical insurance, you will be required to pay all amounts due within thirty days.

As a courtesy to you, we will bill your auto insurance company directly for medical service rendered. To bill your claim directly, you must provide us all necessary
information to confirm coverage for these payments with the auto insurance. We will also collect information about your personal medical insurance in case the auto
carrier denies your claim. If our providers are not in-network with your health insurance plan, you will be expected to pay at the time of each service and you must have a
credit card on file. As a courtesy, we will then bill to your auto insurance and reimburse you for any payments we’ve received from the auto carrier. Regardless of whether
we submit your claim to auto insurance, as the patient, you are ultimately responsible for payment.

If you do not have insurance coverage, your providers are out-of-network with your insurance plan, or you have elected to waive the opportunity to file a health insurance claim, you will be expected to pay at the time of service, and you must have a credit card on file. Pre-payment may be requested for surgeries, procedures, or ancillary medical services. Boston Orthopaedic & Spine, LLC provides Good Faith Estimates that show the costs of items/services that are reasonably expected for an item or service. The estimate is based on information known at the time the estimate was created and does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill. If you are billed for more than this estimate, you have the right to dispute the bill. You may contact our Billing Department at 617-588-3098 to let them know the billed charges are higher than this estimate. You can ask them to update the bill to match this estimate, ask to negotiate the bill, or ask if there is financial assistance available. You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). You must start the dispute process within 120 calendar days of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount. To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 617-573-1600. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 617-573-1600.

Think of CareCredit as your own health, wellness and beauty credit card.

Whether it’s for stem cells, platelet rich plasma (prp), shockwave, orthotics, viscosupplementation or other out of pocket expenses such as deductibles or coinsurance, you shouldn’t have to worry about how to get the best medical care. That’s why we’re pleased to accept the CareCredit health, wellness and beauty credit card. CareCredit lets you say “Yes” to recommended surgical and non-surgical procedures, and pay for them in convenient monthly payments that fit your financial situation.

With special financing options*, you can use your CareCredit card again and again for your medical needs, as well as at 200,000 other healthcare providers, including dentists, optometrists, veterinarians, ophthalmologists and hearing specialists.

It’s free and easy to apply and you’ll receive a decision immediately. If you’re approved, you can schedule your procedures even before you receive your card. With more than 21 million accounts opened since CareCredit began nearly 30 years ago, they are the trusted source for healthcare credit cards.

Learn more by visiting www.carecredit.com.

Affirm offers flexible “buy now, pay later” financing options for healthcare, allowing patients to pay for treatments over time with transparent, 0% APR or interest-bearing plans.

Learn more at https://www.affirm.com/.

There is an administrative fee for completing forms such as DMV, physical forms, FMLA, leave of absence, disability etc. Most forms require 5 to 7 business days to research your information and complete the form. A yearly fee of $35 per calendar year (a one-year period between January 1 and December 31) is due for completion of these forms.

By signing below, the undersigned acknowledges that: (1) I have read, understand, and agree to the specified terms of the Patient Financial Responsibility Policy. (2) I authorize Boston Orthopaedic & Spine, LLC to release all medical information to insurance carriers and or Centers for Medicare/Medicaid concerning my treatment and I hereby assign payment to Boston Orthopaedic & Spine, LLC for services rendered to myself/my authorized dependent. (3) I agree that I AM RESPONSIBLE FOR ANY AMOUNTS NOT COVERED BY MY INSURANCE. (4) I authorize Boston Orthopaedic & Spine, LLC and/or any entity authorized by my healthcare provider to contact me about my financial responsibilities, via phone email or text, at any telephone number, email address and/or mailing address provided.