Urgent Care Billing

Urgent Care services are available at multiple Mass General Brigham locations.

The billing information below does not apply to Urgent Care services provided at centers named “Mass General Brigham Urgent Care” located in Boston and surrounding communities.

How Urgent Care Billing May Affect You

Since the locations listed below are not considered by health insurance plans to be Urgent Care Centers, your co-payment benefits for urgent care services typically will not apply. Instead, your visit to these locations will likely be billed either as a physician office visit or a hospital outpatient visit.

Physician Office Locations

Urgent Care services provided at the following Mass General Brigham locations are typically billed to your health insurance plan as a physician or nurse practitioner office visit:

• Cooley Dickinson Urgent Care, Northampton, MA
• Harbor Medical Associates Urgent Care, South Weymouth, MA
• North Shore Urgent Care, Danvers, MA
• Pentucket Medical ExpressCare Andover, MA
• Lawrence, MA

Hospital Outpatient Locations

Urgent Care services provided at the following Mass General Brigham locations are typically billed to your health insurance plan as a hospital outpatient visit:

• Massachusetts General Hospital Primary Care Urgent Access Center, Boston, MA
• Massachusetts General Hospital Chelsea HealthCare Center Urgent Care, Chelsea, MA
• Brigham and Women’s Urgent Care Center, Foxborough, MA
• Newton-Wellesley Urgent Care Center, Waltham, MA

Understanding Whether My Urgent Care Visit Takes Place at a Physician Office or a Hospital Outpatient Center

You can find information about whether your visit is a physician office or hospital outpatient visit in notices in our waiting rooms, on the websites of our hospitals and physician groups, and in this guide.

Payment Responsibility for Urgent Care Services at the Locations Listed in This Guide

For physician office locations:

Urgent Care services are typically billed as a physician or nurse practitioner visit, and your out-of-pocket costs are usually limited to the co-payment required by your health insurance plan.

We will request your co-payment when you check in for the visit.

For hospital outpatient locations:

Your out-of-pocket costs for the physician or nurse practitioner visit are usually limited to the co-payment required by your health insurance plan. We will request your co-payment when you check in for the visit.

You will also be billed for what is commonly known as a “facility fee” for use of the hospital space, equipment, and support staff.

Your health insurance plan may apply these hospital fees to your annual deductible, and after you have paid your deductible in full, you may be billed for a co-insurance payment.

We will send you a bill if there is any unpaid balance after we receive payment for your visit from your health insurance plan.

Referrals and Prior Authorizations

For both physician office visits and hospital outpatient visits, your health insurance plan may require you to get a referral or authorization. In addition, Mass General Brigham providers may be considered “In Network” or “Out of Network” depending on the specifics of your health insurance plan, which could affect the amount you pay.

Billing for Procedures Performed During the Visit

No matter the location, if a procedure is performed during the visit, you may have further out-of-pocket costs for additional physicians’ services and for use of the hospital facilities and staff, even if the procedure was performed in the same exam room as the visit with the physician. Your health insurance plan may apply these additional physician and hospital charges to your annual deductible, and after you have paid your deductible in full, you may be responsible for an additional co-insurance payment.

Laboratory and Imaging Services

If your physician ordered laboratory tests or imaging services (such as X-ray, CT or MRI), you will be billed for these tests by the hospital, clinical laboratory, or imaging center, and you may also be billed for the services of the physicians (usually pathologists and radiologists) who interpreted the test results.

Special Notice for Medicare Patients

If you are a Medicare beneficiary and your visit takes place in a hospital outpatient location, you will be responsible for a Medicare Part B out-of-pocket co-insurance payment of approximately $25 for the hospital facility charge. Procedure charges or other testing could increase your out-of-pocket expense.

Understanding How Much My Visit Will Cost

It is your right to receive an estimate of the cost of your visit in advance of the visit. Please contact Mass General Brigham Patient Billing Solutions (see below) at least two business days prior to your visit to get an estimate. Please have as many details as possible about the upcoming visit, including the provider name, location, and details of the planned service or procedure.

Please contact the Member Services department of your health insurance plan to verify your coverage and financial responsibility for Urgent Care services provided at any of the locations listed on this page. This phone number is usually located on your insurance card.

 

Updated April 2019