Commercial Health Insurance

Rev. 09/30/2024

Upon request, we provide a service filing out-of-network claims to most commercial health insurance policies with out-of-network benefits. HMO plans do not include out-of-network benefits except in the rarest of situations.

Policyholders who wish to use our claims filing service must submit their insurance card information to us and provide insurance information on our Patient Information form. We check eligibility and level of benefits with the insurer and inform you of the results. If you’re unable to provide the required information ahead of time, we will verify benefits after your first appointment.

We may be able to file out-of-network medical claims with certain Anthem, Aetna, United Healthcare, Optum, Cigna Healthcare, and Harvard Pilgrim policies. We are adding more as permitted. However, we are not in-network with any health insurance company with the exception of Optum for VA-referred patients only.

Physician Referrals

When physicians make a formal referral, the doctor’s office sends or faxes the referral order to us with all the necessary information we require to file claims on your behalf. If we have any questions regarding the referral, we endeavor to resolve those immediately.

Once the referral is received, we contact the patient for a short telephone consult and scheduling patient’s initial visit. We ask that the patient brings in their health insurance card at that time and we will make a copy of it for our records.

Self-Referrals

Claims require us to include one or more diagnosis codes for conditions treated. We may also require the name of a diagnosing physician and the hospital/clinic/office name and address. Your insurance company may want a letter of medical indication, referral, or prescription from your physician.

To assist with these requirements, please print or pick up from our office our Insurance Preparation Information Sheet. This form is for recording convenience. You may either ask your physician for the information or give them the form to complete since no signature is required. Please complete form in its entirety.

Financial Responsibility

Out-of-network insurance claims generally reimburse the patient unless they are contracted to pay the non-participating provider directly. Payment for services rendered is expected at the time of service. If you wish to leave a credit card on file with us rather than present the card at each visit, please let us know. Our merchant services provider (SquareUp) maintains on-file credit card information. We do not store credit card information on our devices or in our files except permissions.

Insurance typically covers around 50-70% of out-of-network care with the responsibility of the remaining costshare left to the policyholder. On the other hand, 90-100% of in-network care is covered by the policy when patients see the insurance company’s preferred providers. Therefore, it may behoove you to find an in-network provider if your resources are limited.

Additionally, insurance companies reduce the reimbursed amount to the patient by any deductible you still owe at time of service, any copays, coinsurance, and any uncovered amount, meaning the difference between our charges for a procedure and their customary reimbursement computations for non-participating / out-of-network providers.

The No Surprises Act

Please note that the Department of Health and Human Services developed standard notice and consent documents under section 2799B-2(d) of the Public Health Service Act entitled the No Surprises Act in 2022. This Act is aimed at nonparticipating providers, directing them to disclose good faith estimates of their cost of services to prospective patients and to remind patients they will pay less if they go to in-network providers.

We should note that we always provide good faith estimates for any service booked in our online scheduler as well as in our appointment confirmation emails, and will continue to do so. We also disclose all evaluation, service, miscellaneous fees and charges in our website under the Services tab.

Regardless, since Manchester Bedford Myoskeletal is a nonparticipating provider due to insurers unwillingness to contract with our provider type, we fall under the No Surprises Act. Therefore, we will furnish prospective insurance patients with a Standard Notice and Consent document as required by law beginning October 1st, 2024. We provide a blank sample of this document for you here. New patients will receive the completed document via email when their appointment is booked more than 72 hours prior to the scheduled visit. If booked less than 72 hours, the document will be presented upon patient’s arrival.

Important Information to Know For Private Insurance:

1. Your health insurance company (HIC) may choose to reimburse your claim(s) in part, in full, or may deny claims altogether for any reason. We will do everything we can to assist you in filing claims, supporting documentation, or any information required to help ensure you are reimbursed appropriately and in a timely manner.
2. Your HIC may deny patient benefit eligibility at any time, even after approving it. We cannot submit a claim if eligibility is denied. Patient must contact insurer directly.
3. Letter of Medical Indication – Your HIC may require a signed document of medical indication or prescription for massage therapy or any of our other billable services from your primary care or attending physician. When required, your physician must provide a signed letter on office letterhead. It must include a diagnosis and/or diagnosis code and referring physician’s NPI number. HICs will generally not accept this letter by any other media (i.e., non-office stationary, email, text message, etc.).
4. Even after providing a properly prepared letter of medical indication, your HIC may deny your claim on the grounds that they decided your treatment was NOT medically necessary. Insurance company physicians determine medical necessity and patient’s physician determines medical/clinical indication. These nuanced terms form the basis for many denials regardless of the procedure.
5. Payment for all services performed by Manchester-Bedford Myoskeletal LLC is the responsibility and at the expense of the patient. Acceptable forms of payment are cash, credit/debit card, and Apple Pay, Google Pay, Samsung Pay, and contactless cards. We do not retain any credit card information on any device and we do not have access to that information.
6. We also accept payments from Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA). HSA and FSA acceptance account rules vary by individual plans. To avoid surprises, we suggest patients check with their HSA/FSA plan managers beforehand to ensure they approve use of the plan for clinical massage therapy.
7. Health insurance does not reimburse for missed appointment, no-show, or late cancellation fees.

Please note services rendered in our clinic are between Manchester-Bedford Myoskeletal LLC and the patient/guardian and not with any private insurance company. We simply offer claim filing as a service to our patients. Your insurance company will send you a statement (Explanation of Benefits or EOB) by mail or electronically describing the portion of the claim you are responsible for. However, as we have no contractual agreement with commercial insurers to accept any predetermined amount for service as a credentialed in-network provider has, insurers have no legal standing to alter your responsibility for our full payment. You are solely responsible for paying all charges resulting from services rendered and other charges as described in our Policies. Please speak with our office manager if you have any questions in this regard.