General Information

• General Information about financial assistance
• Financial Assistance and uninsured patient discount policy
• Patient Billing Terms
• List of patient financial counselor’s contact information across Partners entities
• Why am I getting a bill?
• Credit and collection policy
• Financial Assistance Application Form

Financial Assistance in other languages

• Arabic
• Cantonese/Mandarin
• French
• Haitian Creole
• Italian
• Khmer
• Portuguese
• Russian
• Spanish
• Vietnamese

Urgent Care Billing at Partners HealthCare

Urgent Care services are available at multiple Partners HealthCare locations.

The billing information below does not apply to Urgent Care services provided at centers named “Partners Urgent Care” located in Boston and surrounding communities.

How Urgent Care Billing May Affect Me

Since the locations listed below are not considered by health insurance plans to be Urgent Care Centers, your co-payment benefits for urgent care services typically will not apply. Instead, your visit to these locations will likely be billed either as a physician office visit or a hospital outpatient visit.

Physician Office Locations

• Urgent Care services provided at the following Partners HealthCare locations are typically billed to your health insurance plan as a physician or nurse practitioner office visit:
• Cooley Dickinson Urgent Care, Northampton, MA
• Harbor Medical Associates Urgent Care, South Weymouth, MA
• North Shore Urgent Care, Danvers, MA
• Pentucket Medical ExpressCare Andover, MA • Lawrence, MA

Hospital Outpatient Locations

• Urgent Care services provided at the following Partners HealthCare locations are typically billed to your health insurance plan as a hospital outpatient visit:
• Brigham and Women’s Urgent Care Center, Foxborough, MA
• Newton-Wellesley Urgent Care Center—Waltham, Waltham, MA
• Massachusetts General Hospital Chelsea HealthCare Center Urgent Care, Chelsea, MA
• Massachusetts General Hospital Medical Walk-In Unit, Boston, MA

Understanding Whether My Urgent Care Visit Takes Place at a Physician Office or a Hospital Outpatient Center

You can find information about whether your visit is a physician office or hospital outpatient visit in notices in our waiting rooms, on the websites of our hospitals and physician groups, and in this guide.

Payment Responsibility for Urgent Care Services at the Locations Listed in This Guide

For physician office locations:

• Urgent Care services are typically billed as a physician or nurse practitioner visit, and your out-of-pocket costs are usually limited to the co-payment required by your health insurance plan.
• We will request your co-payment when you check in for the visit.

For hospital outpatient locations:

• Your out-of-pocket costs for the physician or nurse practitioner visit are usually limited to the co-payment required by your health insurance plan. We will request your co-payment when you check in for the visit.
• You will also be billed for what is commonly known as a “facility fee” for use of the hospital space, equipment, and support staff.
• Your health insurance plan may apply these hospital fees to your annual deductible, and after you have paid your deductible in full, you may be billed for a co-insurance payment.
• We will send you a bill if there is any unpaid balance after we receive payment for your visit from your health insurance plan.

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.

Billing for Procedures Performed During the Visit

No matter the location, if a procedure is performed during the visit, you may have further out-of-pocket costs for additional physicians’ services and for use of the hospital facilities and staff, even if the procedure was performed in the same exam room as the visit with the physician. Your health insurance plan may apply these additional physician and hospital charges to your annual deductible, and after you have paid your deductible in full, you may be responsible for an additional co-insurance payment.

Laboratory and Imaging Services

If your physician ordered laboratory tests or imaging services (such as X-ray, CT or MRI), you will 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.

Special Notice for Medicare Patients

If you are a Medicare beneficiary and your visit takes place in a hospital outpatient location, you will be responsible for a Medicare Part B out-of-pocket co-insurance payment of approximately $25 for the hospital facility charge. Procedure charges or other testing could increase your out-of-pocket expense.

Understanding How Much My Visit Will Cost

It is your right to receive an estimate of the cost of your visit in advance of the visit. Please contact Partners Patient Billing Solutions (see below) at least two business days prior to your visit to get an estimate. Please have as many details as possible about the upcoming visit, including the provider name, location, and details of the planned service or procedure.

Please contact the Member Services department of your health insurance plan to verify your coverage and financial responsibility for Urgent Care services provided at any of the locations listed on this page. This phone number is usually located on your insurance card.

If Your Insurance Company Does Not Answer all of Your Questions, Please Contact Partners Patient Billing Solutions:

Mailing Address
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

Email
patientbilling@partners.org

www.partners.org/patientbilling

Preventive Health Exam Billing at Partners HealthCare

What is a Preventive Health Exam and is it Covered by My Insurance?

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

• Ask you questions about your health
• Do a physical examination
• Give you advice about how to prevent health problems
• 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:

• Ask you questions about your health, and family and social history
• Provide advice about how to prevent health problems, including a plan for screening in the future
• 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, Please Contact Partners Patient Billing Solutions:

Mailing Address

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

Email
patientbilling@partners.org

www.partners.org/patientbilling 

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

Effective 1/1/22

Read more about your rights and protections against surprise medical bills

Updated Dec 2021