You will be considered a Self Pay patient if one of the following applies:
- No health insurance or
- Inactive insurance coverage or
- Having an insurance plan that doesn't cover the services we provide or
- Not obtaining an insurance referral at or before the time of service
In order to be seen Self-Pay patients are required to pay a $140 deposit at the time of service. The deposit is reduced to $100 for established patients. This payment will be applied to your final bill for the visit.
Charges are determined based on standard medical coding and billing practices and are dependent on a variety of factors; which include the type and nature of the visit, and other services or procedures performed during the visit. Therefore, an additional bill may follow depending on the services rendered.
Also, patients who require lab work and durable medical equipment may receive additional charges.
A Helpful Guide to Decoding Your Insurance Coverage:
Premiums: The amounts you pay for your insurance policy, often deducted directly from your paycheck.
Deductibles: Are paid out of pocket each year before insurance kicks in. Each family member usually has a separate deductible.
Co-Payments: Are flat fees charged each time you visit the doctor or use any medical service, regardless of the cost of the procedure.
Co-Insurance: Requires you to pay a percentage of the total cost of care. Many plans require either co-insurance or co-pay, but some charge both.
Maximum out of pocket: Is the most you'll have to spend before all of your medical bills are covered.
Insurance referrals are predominantly required for any HMO plan. If you are not sure if your insurance requires a referral you can do the following:
- Look on the back of your insurance card (sometime it will list it as a requirement)
- Call insurance member services (number usually on back of card) and inquire.
- Call us, OnCall Urgent Care at 413-584-7425, option 4, and speak to a receptionist. We can give you the necessary information to get the referral process started if one is required.
Can I Be Seen If I Have Not Yet Received A Referral?
If your doctors office is busy, it may take a while for them to
submit a referral to your insurance carrier. Therefore, Urgent Care
patients can be seen without receiving a referral up front, but they must sign the Self-Pay agreement and pay a $140 deposit at the time of service. This payment will be reimbursed once the referral is processed.
Unfortunately this option is not available for any MassHealth insurance products.
How to Get a Referral:
We are more than willing to help, but it is primarily the patient's responsibility to obtain a referral from the primary care provider (PCP). To do this, call your PCP and ask to speak
to someone about an insurance referral. They will ask you for the date
of service and for our National Provider
Identifier Number, or NPI. Please contact us to obtain the correct NPI number for the specific provider you saw or will be seeing. Once the referral is completed, we request that your PCP's office fax us a copy at 413-584-7440.
Suboxone patients need to have referrals for at least 25 visits before being seen.
If your PCP will not give you a referral, you will be considered a "self-pay" patient.