Office Information

Billing and Insurance

Billing Customer Service

Financial counseling is available to all NSPG patients. Through Partners HealthCare, NSPG patients can get: cost estimates for healthcare servicesstandard hospital charges and financial counseling and assistance.

Insurance

We accept most major insurance policies. Find out which insurances we accept.

Prior to your appointment, please contact our office or your insurance company to ensure your visit will be covered. Co-payments and any services not covered by your insurance plan and deductibles are required at the time of your visit. For your convenience, we accept checks, VISA, MasterCard, Discover and American Express.

Urgent Care

Various insurance plans cover urgent care visits differently and these differences may result in your out-of-pocket costs being more than expected. North Shore Urgent Care is billed as a "physician's practice providing urgent care” rather than as an “urgent care center.” Due to this distinction, your insurance company may:

  • Require a referral from your primary care physician
  • Consider us “in network” or “out of network” depending on the specifics of your plan.

Please call the member service number on the back of your insurance card and ask a representative to confirm your plan’s specific coverage for this office. If the representative cannot find the office by searching North Shore Physicians Group, please ask him or her to look for our group by its national provider number (NPI) 1588606123. Please confirm your plan's details with your insurance company before you receive care. Our staff cannot provide information on eligibility or benefits as each plan varies from one patient to another.

Referrals and Prior Authorizations

For both physician office visits and hospital outpatient visits, your health insurance plan may require you to get a referral or authorization. In addition, Partners HealthCare 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. If a referral cannot be obtained, you will be responsible for the full cost of the visit. Please note that Harvard Pilgrim Health Care now requires a PCP referral to urgent care that has been submitted BEFORE your visit takes place.

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. __________________________________________________________________________________________________________________________________

Your Preventive Health Exam  

Will My Insurance Cover my annual Preventive Health Exam?

A preventive health exam is an Annual Physical during which your primary care provider will:

  1. Ask you questions about your health
  2. Do a physical examination
  3. Give you advice about how to prevent health problems
  4. Take care of minor health problems or a chronic illness that has not changed

Commercial Health Plans

Under the Affordable Care Act, commercial health plans are required to cover an annual Preventive Health Exam at no cost to the patient (no co-payment, co-insurance or deductible).

Medicare Advantage

Many Medicare Advantage plans will also pay the full cost of Preventive Health Exams as defined in this guide.

Medicare Part B --Annual Wellness Visit

Medicare Part B covers a different version of an annual visit, called a “Medicare Annual Wellness Visit.” During your Medicare Annual Wellness Visit your provider will:

  1. Ask you questions about your health, and family and social history
  2. Provide advice about how to prevent health problems, including a plan for screening in the future
  3. Screen you for depression and other mental health or safety concerns

A Medicare Annual Wellness Visit does not include a physical exam. If your provider does perform a physical exam during your visit to assess your health or treat any medical problems, you may be responsible for a co-insurance or a Medicare Part B deductible payment.

“Welcome to Medicare” Visit

During your first 12 months of enrollment in Medicare Part B, a “Welcome to Medicare” visit is covered, which includes a physical examination.

When Would any of These Annual Health Visits Turn into a Sick or Chronic Disease Visit?

Sometimes, your annual Preventive Health Exam, Medicare Annual Wellness Visit, or Welcome to Medicare Visit can turn into a “Sick Visit”. During your visit, your provider may need to treat a new medical issue or a chronic problem that has changed. If that occurs, this part of the visit is called a Sick Visit and may result in additional services being billed to your insurance.

Most insurance companies will pay for Sick Visit evaluations, tests, and treatments, but your insurance plan may require you to pay a co-payment, deductible, and/or co-insurance payment for the Sick Visit, even when it is done during the same appointment as your Preventive Health Exam, Medicare Annual Wellness Visit, or Welcome to Medicare Visit.

Are Lab Tests for Disease Screening and Immunizations Covered During My Annual Health Visits?

Medicare and many commercial health insurance plans cover certain screening tests (such as cancer and cardiovascular disease screening) and immunizations. Specific coverage depends on your age and health insurance plan. Some tests and immunizations may not be covered at 100% and some may not be covered at all. In those cases you may be responsible for a co-insurance or deductible payment.

When Will I Have to Pay?

We will request your co-payment when you check in for a visit. We will send you a bill if there is any unpaid balance after we receive payment for your visit from your insurance company.

It is important that you understand your health insurance benefits, and we encourage you to contact your health insurance plan if you have any questions about what is included in your Preventive Health Exam, Medicare Annual Wellness Visit or Welcome to Medicare Visit, or about charges for Sick Visits, lab tests, immunizations and other services that are performed during your Preventive Health Exam, Medicare Annual Wellness or Welcome to Medicare Visit.

If Your Insurance Company Does Not Answer all of Your Questions:

Patient Billing Solutions

Partners HealthCare

399 Revolution Drive, Suite 410   

Somerville, MA 02145–1462


Phone (617) 726-3884     Monday–Friday, 8:00 AM to 4:30 PM

PatientBilling@Partners.org          www.partners.org/patientbilling