Patient Notice: At ProHealth we are working to make sure federal employees affected by the government shutdown continue to receive the care they need. If you have been impacted by the shutdown and need to discuss payment arrangements, please call us toll-free at (800) 268-2055 or click on Contacting Us for additional ways to reach our billing department.
ProHealth Physicians’ billing operations are focused on ensuring that medical claims are paid accurately and timely while providing high-quality customer service to our patients.
Billing questions can be directed to ProHealth Physicians either by phone, email, or mail.
Customer Service is available Monday through Friday from 8:00am to 4:30pm by calling (860) 409-7700 or toll-free in CT at (800) 268-2055. A Customer Service Representative will answer questions regarding your ProHealth Physicians bill. To expedite your call, please have your current insurance card and ProHealth Physicians account number (shown on the top right hand corner of your statement) available. Messages left outside of normal business hours will be returned the following business day.
Submit a billing question to firstname.lastname@example.org and a Customer Service Representative will respond promptly to your inquiry. Questions submitted outside of normal business hours will be responded to the following business day.
Send a letter including your name, account number, and question to ProHealth Physicians, P.O. Box 419745, Boston MA 02241-9745.
Payment is expected at the time of service. However, as a courtesy to patients, ProHealth Physicians will bill participating insurance carriers for services rendered. To expedite the processing of your claim, complete and accurate insurance information is required. Any balance due after the insurance carrier(s) processes your claim will be billed to you. The billing statement will explain the remaining balance (i.e. copayment amount due, deductible amount due, non-covered service, etc.). If you have any questions or concerns, please contact Customer Service at (860) 409-7700, toll free at (800) 268-2055, or send an email to email@example.com. A Customer Service Representative will be available to review your account and explain the details.
Patient Billing Statement and Payment Options
ProHealth Physicians mails billing statements monthly. Payment is expected upon receipt and prompt payment is greatly appreciated.
Patients can pay an outstanding balance in one of four ways:
- “EASIEST WAY TO PAY” is to pay online! Access our pay online website.
- Mail the top portion of your statement with credit card information or check made payable to ProHealth Physicians, P.O. Box 419745, Boston MA 02241-9745.
- To pay by credit card by phone, call Customer Service at (860) 409-7700 or toll free at (800) 268-2055.
- Pay by cash, check, or credit card at any ProHealth Physicians office.
ProHealth Physicians may charge for missed appointments. At least 24 hours advance notice is requested if an appointment needs to be rescheduled or cancelled.
Completing Forms for School, Work, etc.
ProHealth Physicians may charge for completing school, camp, work, or other forms.
Glossary of Common Billing & Insurance Terms
The maximum amount a plan pays for a covered service.
These are medical services for which your insurance plan will pay (in full or in part).
A request made to an insurance carrier for payment.
A type of cost sharing where the member and insurance carrier share payment of the approved charge for covered services in a specified ration after payment of the deductible by the insurance. For example, the insurance company agrees to pay 80% and the member agrees to pay 20%.
A set fee the member pays to providers at the time services are rendered.
Current Procedural Terminology (CPT) Code
How physicians’ services are identified and defined.
Coordination of Benefits (COB)
A provision that applies when a person is covered under more than one group medical plan.
The determination of whether you or your dependents are insured under a medical plan.
What the insurance company will consider paying for as defined in the policy. For example, generic prescriptions versus brand name prescriptions.
Date of Service
The date(s) medical services were rendered to the member.
International Classification of Diseases (ICD) Diagnosis Code
Codes used by medical providers and institutions to identify medical conditions of patients.
Explanation of Benefits (EOB)
The coverage statement sent by insurance carriers to covered persons and providers listing services rendered, amount billed, and payment made. In addition, patient responsibility amounts are also explained, such as co-insurance, co-payments, and deductible amounts.
A licensed or certified individual that provides medical services to patients.
An agreement in which a person makes regular payments to a company and the company promises under contract to pay for certain medical services. Health insurance may apply to a limited or comprehensive range of medical services and may provide for full or partial payment of the costs of specified services.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic healthcare transactions and national identifiers for providers, health insurance plans, and employers.
Health Maintenance Organization (HMO)
An entity that provides or arranges coverage of designated health services for plan members for a fixed, pre-paid premium.
Health Savings Account (HSA)
A “savings” account typically established by an employer and employee to help save money to pay for medical expenses and prescriptions. It is funded with tax-free contributions by the account holder and may also include a contribution from the member’s employer.
Health Reimbursement Account (HRA)
Similar to an HSA, but it is only funded by a member’s employer.
High Deductible Health Plan (HDHP)
A type of plan that is offered by an insurance carrier that requires the member (or family) to reach a certain dollar amount in medical expenses before the insurance carrier pays for covered services (i.e., $3000 family deductible). Once a deductible is reached for the calendar year, the traditional healthcare coverage plan will become available and claims are paid at either 100% or the percentage specified in the policy.
A federal program jointly funded by states and the federal government which provides medical insurance coverage.
Maximum Out of Pocket
The most money you can expect to pay for covered expenses. The maximum limit varies from plan to plan. Once the maximum out-of-pocket has been met, the health plan will pay 100% of certain covered expenses.
A jointly funded, federal health insurance program providing medical benefits for certain low-income people.
A federal health insurance program providing medical benefits for people over 65 or disabled people.
Medicare Part A (Hospital Insurance)
A federal hospital insurance program that partially pays for inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home healthcare.
Medicare Part B (Medical Insurance)
A federal health insurance program that covers doctors’ services. It also covers other medical services that Part A does not cover, like physical and occupational therapy.
Physicians, hospitals, and other healthcare providers that an HMO, PPO, or other managed care network has selected to provide care for its members.
Non-Participating Provider (Non-par)
A healthcare provider who has not contracted with a health plan to be a participating provider of healthcare; also known as out-of-network provider.
Out of Network (OON)
Treatment obtained from a non-participating provider. Typically, it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider. Insurer may also deny entire claim.
A provider who has contracted with the health plan to deliver medical services to covered persons. The provider may be a hospital, pharmacy or other facility, or a physician who has contractually accepted the terms and conditions as set forth by the health plan.
Point-of-Service Plan (POS)
Managed care product that offers enrollees a choice among options when they need medical services, rather than when they enroll in the plan. Enrollees may use providers outside the managed care network, but usually at higher cost. (This should not be confused with POS as used in retail pharmacy, where it stands for point of sale.)
An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance for approval of certain medical procedures, such as outpatient surgery, in order for those procedures to be considered a covered expense.
Preferred Provider Organization (PPO)
A program that establishes contracts with providers of medical care. Providers under such contracts are referred to as a preferred provider. Usually, the benefit contract provides significantly better benefits and lower member costs for services received from preferred providers, thus encouraging covered persons to use these providers.
Amount paid periodically to purchase health insurance benefits.
Primary Care Physician (PCP)
A physician, the majority of whose practice is devoted to internal medicine, family/general practice, and pediatrics. An obstetrician/gynecologist sometimes is considered a primary care physician, depending on coverage.
Approval or consent by a primary care physician for patient referral to ancillary services and specialists.
An insurance policy or program that pays second on a claim for medical care.
A physician who specializes in a specific area of medicine, such as cardiology, oncology, urology, etc.
The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in a health insurance plan.
To have more of your billing questions answered, visit our FAQ page.