Billing & Financial Services

Before Your Visit

Contact your health insurance company before your first visit to Joslin to prevent any issues with coverage.

When you call your insurer, ask:

• Is Joslin in my network for coverage?
• Do I need a referral from my PCP?
• Do I have a co-pay, co-insurance, and or deductible? If, so what is it?
• Is Diabetes Self-Management Training/Education and/or Medical Nutrition Therapy (MNT) covered? If yes, are there any limitations? If so, please provide details.
• Do you cover diabetes supplies, including blood glucose meters? Which supplies, brands, quantities?
• Do you cover medications? Are there restrictions as to which types, brands, or quantities? Do I need to purchase them from a particular source?
• Do you cover lab tests? Are there restrictions as to which types, locations, and how often they can be done?

When you call your insurance company, make sure to keep a record of:

• The date and time
• The name of the person with whom you spoke
• The specific questions you asked
• A summary of the answers you were given

Finally, insurance cards are a good source of information. They often contain details about websites and phone numbers for customer service representatives you can contact for assistance. Always bring your insurance card to your appointment(s) to make sure Joslin has the most up-to-date information on file.

Joslin in Boston is a participating provider for:

• Aetna/US Healthcare HMO & Non-HMO
• Allways Health Partners
• Blue Cross Blue Shield of Massachusetts (all plans)
• CignaCommonwealth Care Alliance
• Evercare
• Eye Med
• First Health Network
• Harvard Pilgrim Healthcare
• Harvard Pilgrim First Seniority
• Health New England
• Health Plans Inc.
• Humana
• Mail Handlers
• Mass Health/Mass Medicaid
• Mass Behavioral for Mental Health
• Medicare
• Optum
• Out of State Blue Cross Plans
• RailRoad Medicare
• Secure Horizons
• Tricare for Life
• Tufts HMO*/Tufts Total/Tufts Benefit Administrators
• Tufts Public Health
• UMR
• Unicare/GIC
• United Student Insurance

Additional Insurance Information

If your insurance requires a prior authorization, it must be obtained from the insurance carrier and can take up to 3 to 4 weeks. Joslin frequently adds or changes its managed care memberships. Also, Joslin Diabetes Centers in other locations may hold different provider memberships. If you have questions about insurance, call us at 781-744-5554.

Yes, it is very important that you bring your insurance card with you to ensure we have accurate billing information to file your claim. You will be asked to present your card each time you check-in for your appointment.

Joslin Diabetes Center accepts most insurance plans. However, please review our current list of insurances. In some cases, we are considered out-of-network or in a tiered network, and you may be subjected to increased out-of-pocket expenses. Please verify your benefits and coverage limitations directly with your insurance beforehand.

In Network

This means that your insurance company has contracted a negotiated rate, with a wide range of doctors, hospitals, labs, pharmacies, and other providers, for your health care services. These providers have agreed to accept the contracted rate as payment in full – that rate includes both your insurer’s share and your share of the cost. Your share may include a co-payment, a co-insurance, and/or a deductible.

Out of Network

Providers who have not agreed to a contracted rate are considered “out of network.” If you are seen or receive services from an out-of-network provider, your portion of the cost of your care will be higher. Also a provider maybe part of the network, but out of your network area.

Please contact your insurance company directly to confirm if Joslin Diabetes Center is part of your network.

HMO

If you are enrolled in an HMO (Health Maintenance Organization), you will need to select a primary care physician (PCP) and receive most or all of your services from a network provider. If you need to see a specialist or receive specialist services, that provider must also be in your HMO network, and your PCP will need to provide you with a referral for that specialist service.

PPO

A PPO (Preferred Provider Organization) contracts with a network of “preferred” providers from which you can choose. This type of plan does not require a PCP and you do not need to obtain referrals to see other providers in the network.

If your care is from a provider within the preferred network, you will only be responsible for your deductible and copayments. If you receive services from a provider that is not in the “preferred” network – which is commonly known as going “out of network” – you will be responsible for a higher balance.

Your co-pay is due when you check-in. If you are unsure of your financial liability, please refer to your insurance card, or contact your insurance directly. Our Patient Financial Counselors are also available to assist you in determining your cost.

A statement will be sent to the patient/guarantor. Within 20 days of receipt of the statement, the patient/guarantor is expected to make full payment or to contact our Patient Financial Counselors to establish a payment plan.

Bills can either be paid by phone, online or by mail:

• Pay by phone: The phone number for the billing department is 781-744-5554. Please have your credit card information available when you call.
• Pay online
• Pay by mail: Make the check, money order, or credit card payable to Joslin Clinic and include your patient account number. Mail to:
  
  Joslin Diabetes Center
  PO Box 986505
  Boston, MA 02298-6505

Joslin’s Patient Financial Counselors are available to assist you with establishing an affordable payment plan. Please call 617-309-4187 or 617-309-5712 to discuss your options.

The billing office is open 8:30 am to 5:00 pm, Monday through Friday.

We will bill all insurances directly. Please inform us of any changes to your insurance coverage by calling our centralized appointments office at 617-309-2440 for your next visit or the Billing office at 781-744-5554 for any current charges.

Your initial statement or bill will provide a summary of charges and payments. If you require a detailed and itemized bill, please contact our billing office at 781-744-5554.

Yes. If you are a member of an HMO, you probably need a referral. To find out for certain, contact the customer service office of your insurance carrier. The telephone number is usually on the back of your insurance card.

How to obtain a referral?

• Call your primary care doctor's office and ask to speak with the person who handles referrals.
• Tell that person the name of the Joslin specialist and when your appointment is scheduled.
• Ask for the "referral number."
• Ask the primary care office to fax the referral to Joslin at 617-309-5705 to the attention of the Referral Coordinator.
• If you are scheduled for an upcoming visit, and we do not have your referral on file, the Referral Coordinator may contact you for your referral number.
• Always bring the referral number when you check in for your Joslin visit.
• If we do not receive a referral, you will be asked to sign a waiver assuming responsibility for payment of services rendered.

Remember to bring the following items to your appointment:

• Your insurance card
• Your co-pay
• Your referral number, or have it faxed to 617-309-5705

You are responsible for obtaining all necessary pre-authorizations or referrals prior to your appointment. We will call you using the phone number on your account to inform you if these are needed.

Please note that patients who are covered by Fallon, BMC HealthNet, and Celtic Care who do not have a referral or pre-authorization in place at least two days before their appointment will need to reschedule their appointment. Once pre-authorization is in place, an appointment can then be scheduled.

If you need a referral and we have not received it yet, you will be asked to sign a waiver during the check-in process which states that you assume financial responsibility for the cost of the visit in the event that you are unable to obtain a referral. It is your responsibility to contact your primary care physician to fax the referral to 617-309-5705.

You should call your primary care provider to get a referral. Joslin Patient Accounts staff is happy to help you determine whom you need to call.

Your insurance company will deny the services and you may be held responsible for the bill.

Patients who do not have a primary care provider (PCP), who require assistance selecting a PCP or who wish to confirm their PCP, should contact their health insurance provider.