Before scheduling your hospital visit, check with your health insurance provider to see if you are covered and learn the specifics of your coverage. Insurance plans are agreements made between you and your insurer, and Massachusetts General Hospital cannot ensure that an insurance provider will pay for your care. It is your responsibility to understand what types of coverage your health insurance provides and to be sure that you meet all requirements stipulated by your specific plan.
Your health insurance provider will be able to inform you of your level of coverage and what, if any, copayments, coinsurances and deductibles will be your responsibility. If you do not contact your provider, you can be ultimately be responsible for all or a large portion of your bill.
Managed Care and Prior Approvals
If you are enrolled in a managed care group, such as an HMO or PPO, you might need a referral from your primary care physician. Please contact your physician for authorization before your appointment, elective procedure or admission to the hospital. Depending on your insurance provider, you might be required to pay a deductible or copayment. In some cases, a deposit can be required. An admitting office coordinator will discuss any deposit details with you.
If you are admitted to the Emergency Department and belong to a managed care group, such as an HMO or PPO, you must notify your primary care doctor and insurer as soon as possible. If you fail to do this, your insurer might not agree to pay your entire bill. Mass General will make every effort to notify your insurer that you are in the hospital, but this is ultimately your responsibility.
Before scheduling a second-opinion consultation at Mass General, be certain to discuss second-opinion requirements with your insurance company, who can tell you if precertification is required.
Uninsured or underinsured patients can also be eligible for financial assistance through Mass General’s Office of Patient Financial Services (see below).
Financial Access Unit
The Financial Access Unit will verify insurance coverage and benefits for patients who have been scheduled for a procedure or hospital stay. The Financial Access Unit also works directly with physicians’ offices and insurance companies to confirm that all required referrals and authorizations have been approved prior a patient’s visit. Contact the Financial Access Unit at 617-726-6828 if you have any insurance authorization questions or concerns.
Patient Financial Services
Mass General offers several programs for patients who are underinsured or who do not have any insurance coverage. Patient Financial Services provides counselors who can assist patients with applying for state-funded programs such as MassHealth and Free Care Programs. Counselors are available who specialize with outpatients, inpatients and emergency room visits. Patient Financial Services is located on the main campus in the Outpatient Registration Department or on the ground floor of the Wang Ambulatory Care Center. To speak with Patient Financial Services, call 617-726-2191.
The staff in the Admitting Office notifies insurance companies of a patient’s pending surgery or hospital admission to obtain prior approval. During this process, someone from the admitting office will contact patients to ensure any necessary information has been received. If you have any questions concerning this process, please call the Mass General Admitting Office at 617-726-3393.