Massachusetts General Hospital accepts most health insurance plans, including Medicare and Medicaid.
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.
Important Medicaid redetermination update
On April 1st, Medicaid (Masshealth in Massachusetts) returned to its normal annual renewal process. If Medicaid has enough information to confirm your eligibility, your coverage was renewed automatically. If Medicaid was not able to confirm your eligibility automatically, you will receive a renewal form in a colored envelope (blue in Massachusetts, yellow in New Hampshire) to the mailing address on file. If you receive any communication from Medicaid in the mail, do not ignore it, act now to avoid disruption or loss of coverage.
Please visit your state’s website to ensure Medicaid has your most current information.
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).
Central Authorization Unit
The Central Authorization Unit will verify insurance coverage and benefits for patients who have been scheduled for a procedure or hospital stay. The Central Authorization Unit also works directly with physicians’ offices and insurance companies to confirm that all required authorizations have been approved prior to care being rendered. Contact the Central Authorization Unit at 617-726-6828 if you have any insurance authorization questions or concerns.
Patient Financial Services
Mass General can help patients who are underinsured or who do not have any insurance coverage. Patient Financial Services counselors can assist patients with applying for state-funded programs such as MassHealth and Health Safety Net. Patient Financial Services is located on the main campus in the Yawkey building on the second floor in suite 2A. To speak with Patient Financial Services please 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.