Financial Checklist for Patients

Confirm Your Insurance Coverage 

• Check the UMass Memorial Health insurance plans accepted list and contact your insurance provider to verify coverage.
• Ensure UMass Memorial is considered "in-network" for your specific plan.
   

Understand Your Insurance Benefits

• Contact your insurance company to confirm benefit coverage before receiving care.
• Review your plan’s tiered or limited network details, as cost-sharing levels may vary depending on where you receive care.
• Verify if referrals or authorizations are required for specific services, as these may affect your coverage.
   

Special Insurance Considerations

• Some insurance plans may use different companies to cover services like behavioral health or transplant-related care. Check with your insurance plan or employer for details. 

Obtain Necessary Approvals and Referrals 

Pre-Authorizations and Pre-Certifications

• Many health plans require pre-certification for procedures, tests, or consultations. Examples include:
  • Outpatient and inpatient hospital services
  • Imaging tests like CT, MRI, and PET scans
  • Colonoscopies and invasive procedures
• Contact your insurance company to confirm if pre-certification is needed and allow up to seven weeks for processing in some cases.

Referrals from Your Primary Care Physician (PCP)

• If your insurance requires a referral to see a specialist, contact your PCP at least one week before your appointment to ensure it is on file.

Plan for Out-of-Pocket Costs

• Be prepared to cover expenses such as:
  • Unmet deductibles, copayments, and co-insurance
  • Self-pay deposits
  • Transportation to and from your appointment

Insurance Coverage and Payment Policies

Avoid Denied or Reduced Benefits

• Know your plan’s pre-certification requirements. Without prior authorization, benefits may be reduced or denied, leaving you responsible for the full cost.
• Managed care plans (HMOs and PPOs): Coverage may be denied if care is obtained outside the approved network or without authorization.

Pre-Service Deposits

• A pre-service deposit may be required if prior authorization is not obtained. Contact your insurance carrier to confirm plan requirements and avoid unexpected costs.

Verify Prior Authorization

• Before your appointment, confirm with your physician’s office that prior authorization has been received.
   

Second-Opinion Consultations

Insurance Coverage for Second Opinions

• Check with your insurance company to see if second opinions are covered.
• Determine if pre-certification is required for a second-opinion consultation at UMass Memorial Health.