Patient Resources

Insurance & Financial Assistance

At GRMDC, we strive to make healthcare as stress-free as possible. Below is a comprehensive list of accepted insurances and important information about billing.

Insurances Accepted at GRDMC

We accept all major commercial insurance plans, MassHealth, BMC Community Alliance, and Senior Care Option plans. If you have questions about whether we accept your plan, please call 617.323.4440.

Call 617.323.4440

Medical Insurance Information

We accept all major commercial plans, Mass Health, BMC Community Alliance, and Senior Care Option plans. To verify if we accept your plan please call 617-323-4440.

Payer	Participants
Aetna	Hospital
Aetna	Physicians
Blue Cross Blue Shield of Massachusetts (BCBSMA)	Hospital (underlies AQC agreement)
Blue Cross Blue Shield of Massachusetts (BCBSMA)	Physicians & CHCs (see TIN list)
Blue Cross Blue Shield of Massachusetts (BCBSMA)	Physicians
BMC Healthnet Plan	Hospital Contract
BMC Healthnet Plan	Hospital Contract (LOA)
BMC Healthnet Plan	Departmental MD Contract
BMC Healthnet Plan	FPF Contract (LOA)
Chickering Claims Administrators	Hospital & Physician
Cigna (formerly HealthSource)	Hospital Contract
Cigna	Physicians
Commonwealth Care Alliance (CCA)	Hospital
Commonwealth Care Alliance (CCA)	(Hospital) MetroBoston Recovery Learning Center & Southeastern Recovery Learning Center
Commonwealth Care Alliance (CCA)	Provider
Commonwealth Care Alliance (CCA)	Family Medicine (by addendum to the Provider Agreement for Inpatient Services Program)
Commonwealth Care Alliance (CCA)	Family Medicine
Commonwealth Care Alliance (CCA)	Evans Medical Foundation
Commonwealth Care Alliance (CCA)	General Internal Medicine
Commonwealth Care Alliance (CCA)	Greater Roslindale Medical and Dental Center
Commonwealth Care Alliance (CCA)	General Internal Medicine & Family Medicine
Neighborhood PACE	Physicians
Fallon	Hospital & Specialists &PCPs
Harvard Pilgrim Health Care (HPHC)	Hospital
Harvard Pilgrim Health Care (HPHC)	Physician
Harvard Pilgrim Health Care (HPHC)	Hospital & Physician
Health Plans Inc.	Hospital & Physician
Humana Military
Kaiser	Hospital & Evans Medical Foundation
MultiPlan (PPO Network Company)	Hospital & Physician (hospital via PHCS agreement; FPF via MPI MOU; integration by amendment to PHCS agreement 10.1.07)
MultiPlan (Beech Street)	Physician
Neighborhood	Hospital Contract
Neighborhood	Physician Contract
Senior Whole Health	Hospital & FPF
Tufts Health Plan	Hospital & FPF
Tufts Health Public Plans (THPP)	Hospital & FPF
TriCare (Healthnet Federal Services, LCC)	Hospital & Physician
TriCare (Formerly CHAMPUS, PHP Healthcare Corporation)	No longer in effect; merged with TriCare
Unicare	Physician Contract
United Healthcare	Hospital Agreement
United Healthcare	Departmental MD Contract
Uphams Elder Svc Plan	Hospital & Physicians
VA Choice	Hospital & Physicians

Dental Insurance Information

Patient Protections Against Surprise Billing

Overview

The following is a detailed overview of federal protections against surprise billing for patients.

On July 1, 2021, the Biden-Harris Administration, through the U.S. Departments of Health and Human Services (HHS), Labor, and the Treasury, as well as the Office of Personnel Management, issued “Requirements Related to Surprise Billing; Part I,” an interim final rule with comment period that will restrict surprise billing for patients in job-based and individual health plans and who get emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.

This first rule implements several important requirements for group health plans, group and individual health insurance issuers, carriers under the Federal Employees Health Benefits (FEHB) Program, health care providers and facilities, and providers of air ambulance services.

Your rights and protections against surprise medical bills

What is “balance billing” or "surprise billing”?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or must pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay, and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing

Emergency services

If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most the provider or facility may bill you is your plan’s in- network cost-sharing amount (such as copayments and coinsurance).

You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protection from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.

Your health plan generally must:

Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by out-of-network providers.
Base what you owe the provider or facility (cost-sharing) on what an in-network provider or facility would pay and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, contact Lysa Thompson, Billing Manager, Greater Roslindale Medical and Dental Center at lysa.thompson@bmc.org.

Visit the websites below for more information about your rights under federal law:

Requirements Related to Surprise Billing; Part I
What You Need to Know about the Biden-Harris Administration’s Actions to Prevent Surprise Billing
Overview of rules & fact sheets

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Tina Oza, RN