Insurance & Referrals

Important Notice

We are excited to announce that we have transitioned to the Epic Electronic Medical Record system as of September 17, 2020. Among the benefits of this transition are a vastly improved patient portal called Patient Gateway. At your first visit to Patriot Pediatrics after Sept. 17, 2020, please ask us for enrollment information to Patient Gateway. 

As part of this conversion, we will be changing our billing service to the MassGeneral Professional Billing Office (PBO).  All patients will need to be registered in the new system before we are able to schedule an appointment as of September 17, 2020. We appreciate your cooperation in updating your child's registration, which will allow your insurance to be billed for the care we provide at our office.  You may contact Patriot Pediatrics to be connected to the MassGeneral Patient Service Center, or you may call them directly at         1-866-211-6588.

Insurance and Related Information

We accept all commercial insurance plans, CHAMPUS, Medicaid, and participate in many managed care plans and HMO's (including Tufts, HMO Blue/Blue Choice, Harvard Pilgrim Healthcare and Aetna/US Healthcare). Please check with us if you are considering changing insurance programs to find out if we participate in that plan. Chances are, we do.

To insure proper billing please provide us with your insurance card for each dependent child at the time of the visit and report any address or phone number changes to our front desk staff. Also, managed care patients must select a Primary Care Provider (PCP) prior to the first visit with our practice; if not you will receive a bill.

Some insurances require copayments at the time of the medical visits. Insurance company policy and our office policy is that copayments must be paid at the time of the visit. We accept cash, check, Visa, or Mastercard.

Please notify us at least 24 hours in advance if you need to cancel or change an appointment. 

Problems associated with financial hardships should be directed to our office manager at the earliest convenience.

Patients choose one doctor from our group to be their "primary care doctor," however, patients may see any provider from our group, regardless of their insurance plan. 

Specialist Visits and Insurance Referrals

Your insurance plan may require that you receive pre-approval from our office before seeing an outside specialist or obtaining other medical services. Please read your insurance information or call your insurance patient relations/customer service coordinator to ascertain whether you need such pre-approval.

If  your doctor has recommended seeing a specialist inside of the MassGeneral Brigham (MGB)  system, then any required insurance referral will be processed automatically. If the specialist is outside of the MGB system, then the following steps are necessary before an insurance referral can be processed: 

  1. Referrals need to be preauthorized by the primary care physician prior to making the first appointment with the specialist.
  2. The appointment with the specialist must then be made. Note that you must have already made the appointment before making the insurance referral request as you will need the date of the appointment, the name of the specialist, and other relevant information to submit this request.
  3. Please call (781) 960-1204. Please have the following information available when you call: Patient's Name; Date of Birth; Telephone; Insurance Company; Policy Number; Suffix; Primary Care Doctor's Name, Specialist name; Specialist Address, Telephone; Fax;  NPI Number (Please ask the specialist when you make the appointment); Appointment Date; Reason for Visit 

The referral staff will be happy to assist you.