Billing and Insurance | Overview
Health insurance plans vary widely in terms of what they cover. For example, different plans have different provisions for coverage of specialist visits and laboratory charges. We are happy to help you navigate your plan’s rules and options to make the process as smooth as possible (see “ Navigating your health insurance plan” and “Frequently Asked Questions” below).
Neurology billing and insurance: Quick reference guide
For all billing questions, please call our Boston Children's Hospital Patient Financial Services Customer Support at 617-355-3397. You can also get general information on the general Boston Children’s Hospital Financial and Billing Matters page.
Please bring your (or your child’s) insurance card to each visit so that we can verify that we have the correct information. If you change insurance companies, please contact us immediately so we can update our records.
Most health plans require an insurance referral from your child’s primary care doctor to receive most other medical services. You may also need prior approval, or “authorization,” from your health plan for the service. These steps will help ensure that the costs of your visits will be covered:
- Before starting the referral process, check with your insurance company about their rules. If you have an HMO/POS plan, chances are that you need an insurance referral from your child's primary care physician. If you have a PPO plan, chances are that you won’t need an insurance referral, but you should always check.
- When you make an appointment with a Neurology provider, be sure to ask for the provider’s ID number or NPI number for your specific insurance. Please also confirm that the provider is a member of your health insurance network. Otherwise, you may be subject to “out of network” costs.
See more under “Navigating your health insurance plan.”
Most insurance companies require that families remit their co-pay at the time of the visit. Please check your insurance card for your co-pay amount. You can pay by check or with a VISA, MasterCard, American Express or Discover Card. We will provide you with a receipt when you check in.
Navigating your health insurance plan
The best way to learn about your specific plan is to contact your employer’s benefits office or your insurance provider. Here are some general things to know about your plan ahead of time:
- Services covered
- Participating health care providers, hospitals and locations covered
- Limits on the number of times you may use certain services and timeframes under which they are covered. For example, insurance may cover a referral for one doctor’s visit that expires in 60 days.
- Cost-sharing provisions, such as co-insurance, co-payments and deductibles. These may vary according to the service (for example, an office visit versus a lab test or imaging test).
- Coverage of inpatient care (for example, hospitalization after an emergency visit) versus outpatient care (a doctor’s office visit)
Does my plan cover neurology care at Boston Children’s Hospital?
Ask your health insurance provider if it considers Boston Children's Hospital to be in-network or out-of-network. You can use language like this:
My child needs services from Boston Children's Hospital. (Explain why this is important for your child's care.)
Do you consider Boston Children’s Hospital to be “in-network,” a “preferred provider,” an "out-of-network or “non-preferred provider”? Will my insurance cover/pay for my child’s visit with this group?
If Boston Children's Hospital is in-network or a preferred provider, ask:
- Is my specialist office visit covered?
- What will my cost-sharing responsibility be?
- Please explain my co-payment (co-pay) co-insurance and or deductible responsibilities.
- Do I need referrals or an authorization for my child to receive care?
If Boston Children's is out-of-network or a non-preferred provider, ask:
- Do I need to obtain a pre-authorization, and if so, how do I get it?
- How much of the cost of the visit(s) will I have to pay?
- Will I need to get this pre-authorization for just the first visit, or will I need it each time if we have more visits?
- In addition to the pre-authorization, will I need to bring a referral from my primary care physician for my child's visit?
- If you do not provide pre-authorization, can I still bring my child to Boston Children's?
Other questions about billing and insurance
How do I know if my insurance is accepted?
We will bill most insurance plans, provided eligibility has been confirmed and the services anticipated are covered under your plan. In some cases, we may be considered as an “out-of-network” provider or part of a tiered network, and you may be subject to increased out-of-pocket expenses. You should always verify your benefits and coverage limitations directly with your insurance company before making an appointment.
My child has health insurance. How much do I owe?
Co-insurance, co-payments and deductibles are determined by your insurance plan; please contact your plan directly to gain a full understanding of what you may owe.
When do I pay my co-pay, co-insurance or deductible?
Co-pays are due when you check in for your scheduled visit. For all other balances, after claims are processed by insurance, you will receive a detailed statement in the mail after your visit.
For all other billing questions, please call our Boston Children’s Patient Financial Services Customer Support at 617-355-3397. You can also get general information on the general Boston Children’s Hospital Financial and Billing Matters page.
Will you bill both my primary and secondary insurances?
We will bill all insurance plans directly.