Billing & Financial Services
Billing, Insurance & Payment Resources
At Lahey Hospital & Medical Center, we are committed to making the payment process as simple as possible. We understand that health plan requirements, coinsurance amounts and rules about coordination of benefits can become confusing, so we are here to help.
Our Commitment to You
At Lahey, we will:
- Bill your health plan, automobile or workers’ compensation insurer for covered services before billing you, except for copays, coinsurance or deductibles known at the time of treatment.
- Conduct business according to the principles that all Lahey employees aim to follow: respect, caring, teamwork, excellence and commitment to personal best.
- Help you apply for the MassHealth, Commonwealth Care and Health Safety Net (Free Care) programs.
- Make reasonable efforts to obtain referrals, authorizations and pre-certifications from your health plan.
- Provide you with interest-free payment plans if you are uninsured or have large balances after insurance.
- Work with you to help you understand your health plan coverage and out-of-pocket responsibility.
Your Responsibilities as a Patient
At Lahey, we ask you to:
- Be sure your health plan or primary care doctor has provided the necessary referrals and authorizations for your care.
- Keep us, and your insurer, up-to-date with your choice of primary care doctor.
- Keep us up-to-date with your personal information, including home address, employer information and telephone numbers.
- Know your insurance coverage and out-of-pocket expenses.
- Pay your copay when you check in for your appointment.
- Promptly pay your coinsurance, deductible or other out-of-pocket responsibility.
- Provide us with your health plan information.
- Tell us when a party other than your health plan will cover a service, such as your automobile insurance or workers’ compensation.
Outpatient hospital services provided by Lahey Hospital & Medical Center with facilities at 41 Mall Road, Burlington; 31 Mall Road, Burlington; 67 South Bedford Street, Burlington; 50 Mall Road, Burlington; One Essex Center Drive, Peabody; and MRI at 16 Hayden Avenue, Lexington; will, in most cases, result in both a Lahey Hospital & Medical Center hospital facility charge and a charge from your doctor.
As a Medicare beneficiary, federal regulations require us to notify you of your financial responsibility for health care services received at our outpatient hospital departments. The intent of this regulation is to ensure that you understand that the services you receive are being provided in a hospital outpatient department, and, therefore, may result in you being responsible for paying a higher co-insurance amount.
For example, a Medicare beneficiary who does not have supplemental Medicare insurance would incur an additional co-insurance amount of $13 for a level three* visit provided in the outpatient hospital department, compared to the same level three visit provided in a doctor’s office setting.
Some commercial health plans also have deductible or coinsurance amounts that apply to some outpatient hospital services. Please check with your health plan if you have questions about your coverage.
*Please note: For more information on these levels, visit the CMS.gov website and search CPT99213.
