Dear Patient:

Welcome to Boston Sports and Shoulder Center. Our mission is to deliver the highest quality of care. As a courtesy, Boston Sports and Shoulder Center will bill your insurance company. Please understand that this is your insurance policy, not ours. Please read our insurance policies and then sign and date at the bottom.

• INSURANCE CARD: Please have this with you so we can copy all of the necessary information. This will make the billing process easier for all of us. If your insurance should change, please inform the office at the time of your next visit.
• CO-PAYS: Have your payment ready when checking in at the front desk. This is a contractual obligation with your insurance company for which you are responsible and it is mandatory that we collect it from you.
• REFERRALS: As a member of an HMO, You have become a partner with your Primary Care Physician (PCP) and it is mandatory that you get a referral from your PCP to see a specialist and have x-rays. THE INSURANCE COMPANY WILL NOT PAY FOR THE VISIT WITHOUT A REFERRAL. Please call your PCP in advance to ask for a referral. If possible, ask to get multiple visits so you do not have to repeat the process every time you come to the office. If a referral has not been obtained and the claim is denied, you will be responsible for payment in full.
• INSURANCE BENEFITS: There are many insurance companies and many plans within insurance companies therefore it is in your best interest to verify benefits. Know your deductible amounts and confirm that the doctor is a member of your plan.
• IF SURGERY IS NECESSARY: Please check with your insurance company to understand what costs you may encounter. Take into consideration that there will be hospital costs as well. We will be happy to direct you to the appropriate person in charge at the hospital or surgery center. We will obtain an authorization number for your surgery if required but this does not guarantee payment.
• WORKERS COMP: In order to schedule an appointment, we need to have your date of injury, claim number, adjuster’s name and telephone number. If you make an appointment using your private health insurance and inform us at any time that it should be a workers comp claim, we reserve the right to cancel your appointment if the claim can not be verified or other payment arrangements are not made.
• MOTOR VEHICLE ACCIDENTS: Boston Sports and Shoulder Center will not bill MVA insurance carries or attorneys for services rendered. All visits are to paid in full at the time of the visit. We will provide you with any documentation in order for you to get reimbursement from your insurance company.
• SELF-PAY: Payment is to be made at the time of all visits.
• SOFT/RIGID ORTHOTICS: Your Physician may recommend that you get Soft/Rigid Orthotics. Please know your insurance coverage for these items. Most time there is a patient portion to be paid.

Our staff will be happy to assist you through any process listed above. We understand insurance policies and programs can be quite confusing. Your patience and understanding will be greatly appreciated in helping resolve any problems.