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Frequently Asked Questions about Accepted Insurance Plans

Get Straightforward Facts about your Health Insurance Benefits 

Here are some questions you should ask your health plan to help you understand your financial responsibilities: 

Is a referral from my Primary Care Physician (PCP) needed to see other providers/specialists?
Please note that some health plans require you to work with your primary care physician to obtain an insurance referral before seeing a specialist or other physician. 

If you haven’t coordinated with your PCP first, some health plans will refuse to cover the service and expect you to cover the entire bill. 

Will I owe a copayment for my health care services?
A copayment is a fixed dollar amount defined in your insurance policy that is your responsibility to pay. 

Some plans vary the amount you pay based on the type of service you receive or where you receive the care. 

For example: you may be charged $20 to see a primary care physician when you are sick but you may be charged nothing for an annual physical or a well-baby visit or $40 to see a specialist provider at the same medical center. 

Do I have a deductible?
A deductible is an amount you owe out of pocket before your insurance company will cover certain health care expenses. 

For example: A health plan may require you to pay $1,000 of your medical care bills out of pocket before they will cover any of the cost of your medical care. 

Is there coinsurance associated with my plan? Coinsurance is the percentage of the total bill for medical services that some insurance plans require the patient to pay even after the deductible is met. 

For example: After you meet your $1,000 deductible, your insurance may cover 80% of your medical bills and expect you to pay for the remaining 20%. 

Is UMass Memorial part of my plan’s network?
Some health plans require a hospital to be part of their network in order to cover medical expenses. 

Your plan may allow you to be seen outside of the plan’s network, but at a higher cost to you. 

Please confirm with your health plan that UMass Memorial Health Care and its physicians are part of your plan’s network or that you are able to access services out-of-network. 

Please note: Latex Balloons No Longer Allowed at Medical Center

Due to allergic reactions to latex and the possible choking hazard for our pediatric patients, these balloons are no longer allowed. Mylar balloons are acceptable to bring into the hospital.