Insurance & Billing

The Patient Accounts Department at Franciscan Children’s is available to service customer billing needs Monday through Friday, between the hours of 6:30 a.m. and 4:30 p.m. The department is staffed by seasoned professionals with many years of experience in the areas of billing and customer service.

Franciscan Children’s is a participating provider in the Medicare and Medicaid insurance programs, as well as Massachusetts Blue Cross Blue Shield and the majority of HMO and Commercial plans.  We also work with non-participating insurance plans on a case-by-case basis to ensure that all of our patients’ financial needs are adequately met.

 

Financial Assistance

Franciscan Children’s is a nonprofit corporation that seeks to provide services to all pediatric patients in need of healthcare. Franciscan Children’s has a Financial Assistance Policy to assist patients and families who have a demonstrated financial need.

To learn more about Financial Assistance and to download an application, please click here or use the button below.

Learn more about Financial Assistance
MassHealth Redeterminations

In March 2020, the federal government declared a public health emergency (PHE) due to the COVID-19 pandemic. In response to the PHE and consistent with federal requirements, MassHealth put protections in place that prevented members’ MassHealth coverage ending during the COVID-19 emergency.  

The federal government has since ended its continuous coverage requirements as of April 1, 2023​. MassHealth is now in the process of renewing all members’ health coverage to ensure they still qualify for their current benefit. These renewals will take place over 12 months, from April 2023 to April 2024. This means that members could get their renewal forms in the mail at any time during this one-year period​.

If you need to renew your coverage, please review the brochure below. For additional questions, please visit Mass.Gov.

MassHealth Redetermination Brochure – English

MassHealth Redetermination Brochure – Spanish

MassHealth Redetermination Brochure – Portuguese

MassHealth Redetermination Brochure – Haitian Creole

MassHealth Redetermination Brochure – Chinese

If you are in need of additional assistance from Franciscan Children’s, please contact our Customer Services Representatives at

customerservicebilling@franciscanchildrens.org or by phone 617-779-1202.

Assistance offered
  • Review and evaluation of a Franciscan Children’s Hospital bill
  • Itemized bills
  • Insurance benefit review- including evaluation of coordination of benefits.
  • Financial Assistance- patients and their families can apply for financial assistance for services scheduled (form will be attached).
  • Obtaining secondary insurance through Mass Health’s office of disability.

Mass Health as a secondary policy through the office of disability Families that meet the Massachusetts residency requirements may qualify for Mass Health as a secondary insurance policy. Patient’s whose medical and behavioral health diagnosis meet the criteria of disability through the state of Massachusetts, can apply. Secondary Mass Health coverage assist with medical bills- doctors who accept Mass Health can submit any patient responsibilities for payment.

Franciscan Children’s patient accounting rep can assist with the application process. Please reach out to our team, the team can be reached at 617-779-1116.

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-networt hospital or ambulatory surgical center, you are protected from balance billing.

What is “balance billing” (sometimes called “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 deductible. You may have additional costs, or you may have to 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 plan’s deductible or 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. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

You’re protected from balance billing for:

Emergency services

If you have an emergency medical condition and receive 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.

Please note: Franciscan Children’s does not offer Emergency Room services. If you feel you are experiencing a medical emergency, call 911 or go to your nearest hospital’s emergency department.

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 types of 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 protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

In addition, under Massachusetts law, you are entitled to certain notices and information regarding the network status of your provider, estimated cost of care and other matters. If your provider is out of network for your health plan, your provider cannot balance bill you for certain scheduled services — beyond the amount you would owe if the provider were an in- network provider — if these notices and information are not provided to you within certain time frames, which vary, depending on when you schedule your appointment.

If you have questions about a bill you have received or have questions about your insurance, you may contact Patient Financial Services Customer Support at 617-779-1202.

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

  • You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in- network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
  • Generally, your health plan must:
    • Cover emergency services without requiring you to get approval for services in
      advance (also known as “prior authorization”).
    • Cover emergency services by out-of-network providers.
    • Base what you owe the provider or facility (cost-sharing) on what it would pay an in- network provider or facility and show that amount in your explanation of benefits.
    • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If you think you’ve been wrongly billed, contact:
The federal phone number for information and complaints is: 1-800-985-3059
Massachusetts Attorney General’s office at 1-888-830-6277, or online at https://www.mass.gov/how-to/file-a-health-care-complaint

Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.

Download the No Surprises Billing Act below:

Hospital Services & Charges

Download the inpatient or outpatient hospital services performed at Franciscan Children’s and the corresponding standard charges.

Click to Download – Price Transparency FY 2024

Click to Download – Franciscan Children’s Charges FY 2024

This list is not intended to provide all of the information needed to estimate the cost of care. There may be other costs in providing your care (for example, the cost of physician services) that are not included in this list. If you’d like an estimate for the cost of your care or have additional questions, please request an estimate or contact Finance and Billing at  617-779-1202.

Please expect a response to your inquiry in 2-3 business days.

 

Please contact our office at 617-779-1202 for further questions.

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