At Centre Pediatrics, we understand that health insurance has become increasingly complex. Our practice bills to many different companies with a wide variety of plans. Because the options and coverage vary considerably, we cannot keep track of the specific details of every plan.
We strongly encourage you to become familiar with your insurance policy so that you understand its rules and coverage. This includes knowing whether well visits, immunizations, laboratory services, and sick visits are covered.
It is essential that you bring your child’s current insurance card to every visit. All insurance companies have time limits for billing claims, and HMO plans often have particularly strict deadlines. When we receive billing information directly from your child’s insurance card, we are better able to meet those filing limits and avoid transferring claims to you.
Important Tips
When you have a new baby, please contact your insurance company immediately and inform the customer service representative that you would like to:
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- Add your new baby to your policy, effective as of the date of birth.
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Designate a Centre Pediatrics provider as your baby’s Primary Care Provider (PCP), effective as of the date of birth.
Record the name of the representative, the date of the conversation, and—if provided—their ID or suffix number (some companies may require this). Emphasize that you wish to receive your physical insurance card as soon as possible.
Once you receive your child’s card, review it carefully to ensure that all information is correct. Some cards require you to add your social security number and signature on the back.
After confirming the accuracy of the information, make a copy of both sides of the card, write your child’s full name and date of birth on the copy, and send it to our Billing Department. Alternatively, you may bring the card to your next appointment and we will copy it for you.
Insurance Plans Not Accepted
Please be advised that Centre Pediatrics does not accept the following insurance plans:
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BCBS – HUGH P (unless prefix is #HUA)
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BCBS – Select Saver Plan
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Blue – HPN or Blue – Select Network Plans
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BMC (Boston Medical Center) – Any & All BMC Plans Not Accepted
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BMC – MassHealth
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Cigna Local Plus / Cigna Local Plus IN (effective 01/01/2018)
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Fallon – MassHealth
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Fallon – Direct Care
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Tufts – Spirit Plan
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Tufts Together (effective 03/01/2018)
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Wellsense – MassHealth
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MassHealth – Standard
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HPHC – Beth Israel Lahey Health Domestic & Community HMO
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HPHC – Quality HMO (effective 07/01/2024)
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HPHC – UHH Local26 Select Plan
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Change of Insurance
If you change insurance companies, it is your responsibility to notify our office as soon as possible. Please send a copy of the front and back of your new insurance card (or your child’s card, if issued separately), along with your child’s name and date of birth, so we can accurately update your records.
Before sending your card, review it carefully to ensure that all information—including name spellings and date of birth—is correct. If you identify any errors, please contact your insurance company directly.
Do not forget to designate a Centre Pediatrics provider as your child’s PCP under the new insurance plan.
Co-Pays
Co-pays are due at the time of your visit. Please be prepared to make your co-payment during check-in at each appointment.
Billing Statements
You will receive a statement (bill) from Centre Pediatrics only when you owe a balance. We try to include the reason that your insurance company has transferred some or all of the charges for your child’s visit to you. Therefore, if you receive a statement in the mail from us, please read it carefully. If you have opted for paperless statements this will appear in Patient Gateway.
If you do not agree with the reason that the insurance company provided for transferring charges to you, please contact your insurance company directly. Most insurance companies have time limits; if your issue is not resolved within that timeframe, all charges become your responsibility. We strongly encourage you to address any billing problems immediately.
If you have questions about your statement, please contact our billing office as soon as possible at 617-713-6203 or email Mfernandes2@mgb.org. In certain cases, we may be able to re-bill your insurance company; however, due to strict filing limits, it is important that any issues be resolved promptly.
Common Reasons Why Charges May Be Transferred to You
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Your insurance company reports that you did not respond to its questionnaire regarding other health insurance.
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Your insurance company indicates that your child is not listed on your plan.
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Your insurance company states that you have not selected a PCP (Primary Care Provider) for your child.
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Your insurance company shows that your coverage is no longer active.
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Your insurance company specifies that the balance due is your deductible, coinsurance, or co-pay.
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Your insurance company notes that your child’s name or date of birth does not match their records.
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Please note that our billing department cannot contact your insurance company on your behalf to resolve these matters. Insurance companies require direct communication with the policyholder (or, in some cases, with your employer’s benefits office).
In these situations, we recommend asking your insurance company’s representative to:
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Correct the necessary information.
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Backdate the corrections to the oldest outstanding claim.
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Reprocess any outstanding claims.
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Be sure to write down the representative’s name, the date, and details of your conversation. If an ID or suffix number is provided, record it carefully. We also appreciate a follow-up call from you to inform us of the steps you have taken to resolve the issue.
Explanation of Benefits (EOB)
Most insurance companies will send an Explanation of Benefits (EOB) to you after processing a claim. This document outlines what portion of the claim was paid and what portion, if any, is your responsibility. If you have questions about your EOB or do not understand it, please contact your insurance company directly.