Phone 781 559 8444
Fax 781 559 8117
687 Highland Ave/Fl 2
Needham, MA, 02494
Patients’ Rights Notice under Massachusetts “Patients First” Law
Under the Massachusetts “Patients First” Law, we are required to inform you of certain rights you have regarding “in-network” and “out-of-network” insurance, advance notice associated with “out-of-network” cost and referral to another health care provider.
Upon the scheduling of any health care service related to a non-emergency encounter, we will inform you whether we participate in your health insurance plan.
If we participate with your health insurance plan, at the time of scheduling your care, you have the right to know how much your health insurance plan will pay for that health care service. This is called the “allowed amount”. You must be provided this information within two days of your request.
Should we be unable to quote a specific amount due to the inability to predict in advance your specific treatment needs or diagnosis, we will tell you the estimated maximum amount that your insurance will pay. We will also let you know the estimated amount of out-of-pocket costs you will be required to pay, including, deductibles, co-pays and co-insurance. You can get additional information about out-of-pocket costs, such as deductibles, co-pays and co-insurance, from your health insurance plan’s toll-free number or website.
If we do not participate with your health insurance plan, we will inform you that we do not accept your health insurance not less than 7 days before your scheduled appointment, unless your visit is scheduled less than 7 days in advance in which case we will inform you not less than 2 days before your scheduled visit or as soon as is practicable before the scheduled appointment, with written notice of that fact to be provided upon your arrival or video sign-on for the appointment.
We will let you know about any expected costs for you, at the time you schedule the appointment. We will let you know that you will be responsible for any costs for you which are not covered by your health insurance plan. We will let you know that you may be able to obtain the same services at a lower cost from another health care provider who participates in your health benefit plan.
If we refer you to another provider for further services, we will tell you if the provider you are referred to is a part of the same “provider organization” as your provider. This would mean that the two providers are in same physician organization, physician-hospital organization, independent practice association, provider network, accountable care organization or another organization that contracts with health insurance companies. We will give you enough information about the provider you are referred to so that you can figure out if this provider is “in network,” which means the provider is covered by your insurance plan or not in-network, as there may be out-of-network costs that apply.
Your health insurance plan has a toll-free telephone number and website where you can find out: (1) if a provider is in your network (2) the estimated or maximum “allowed amount” or charge for a hospital, medical procedure or health care service, and (3) the estimated amount you will be responsible to pay for a hospital stay, procedure or service.
We will let you know to confirm whether the provider you are referred to participates in your health insurance plan by calling the provider and/or your health plan before making an appointment or agreeing to use their services.
If we directly schedule or otherwise arrange for health care services by another provider on your behalf, prior to scheduling we will verify whether the provider to whom you being referred participates in your health plan; and will notify you if that provider is non-participating in your health plan or if network status cannot be verified.
If you believe you did not receive adequate advance notice of your out-of-pocket costs under the Massachusetts Patients First Law, you can file complaint with the appropriate state agency (see https://www.mass.gov/doc/notice-to-patients-on-patients-first-law-gl-c-111-s-228/download.)
