Our billing specialists at CHO are knowledgeable about your insurance coverage, HMOs, Medicare, and MassHealth. Throughout your treatment here, they will be pleased to help you manage your account and help advise you about any billing or reimbursement matters. We understand the cost of cancer care can be overwhelming. Often the indirect costs are also significant, such as rent, mortgage and utilities when you or a loved one is out of work for treatment. At Commonwealth Hematology-Oncology we have Patient Advocates who will help you identify and apply for help with any bills not covered by your insurance.
Insurance and Managed Care
At your first visit, please present documentation if you have insurance coverage or supplemental coverage. If you have MassHealth, please verify this at every visit. Because of recent state and federal laws, we also will need a photo ID at the time of your visit.
During your initial interview, you will need to sign forms regarding your coverage benefits, the release of information to your insurance carrier, and your acknowledgment of financial responsibility. We will enter this information into our computer and will file your insurance claims directly to your insurance carrier.
If you are covered by a Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), or another managed care plan, we will review the conditions of your coverage and our participation in the plan before we begin treatment.
Note that HMO coverage usually requires a referral by your Primary Care Physician (PCP) for hospitalization, office visits, and various procedures. Before each visit to our office, please check with your PCP’s office to be sure you have a valid referral to see us. This is extremely important because your HMO won’t allow us to see you without a valid referral from your PCP. If you come for a visit without a valid referral in place, you will need to pay the entire bill, which can be very expensive, or reschedule your appointment to allow time to get a referral.
Many insurance companies require the patient to pay a copayment at each visit. Your copayment is determined by your employer and the insurance company, not CHO. You will be asked to pay your copay at the time of your visit. By agreeing to accept your insurance to cover your care, Commonwealth Hematology-Oncology must bill you for your copay. If you feel that you need an explanation of your copayment, co-insurance or deductible responsibilities, please ask to speak with the Office Manager who can help you. Our Patient Advocates can assist you if you feel that you cannot afford the copay.
You will receive monthly statements detailing service charges, the status of claims filed, and payments received from you or your insurer.
On the day of your visit, we will ask for all co-payments or unmet deductibles required by your managed care plan. We ask that you also comply with all of your insurance plan’s provisions.
All of our patients have comprehensive medical records, including the results of radiology and laboratory tests, summaries of hospitalization, and physician reports. Because we respect your right to privacy, all of this information is confidential. It will not be released to any outside source without your prior written approval. Please note that most health insurance companies, HMOs, and life insurance and disability insurance companies have already had you sign a form that gives them permission to request any and all of your medical records.
Also note that Commonwealth Hematology-Oncology is taking all necessary steps to comply with the Massachusetts Data Security Law, the Federal Red Flag Law and the Health Insurance Portability Act (HIPAA), which mandates the establishment of national standards for electronic transmission of health data to ensure privacy and reduce costs.