Navigating BMC HealthNet Plan Health Insurance in Boston, MA

As a third year acupuncture graduate student in MCPHS Worcester signing up for a clinical rotation in Boston Medical Center Family Medicine this summer, there are a long lists of immunizations, medical screenings and background check as BMC is a public hospital.

In this process, there are a few blood tests required to confirm that I have the antibodies for Rubella, Tuberculosis, Chicken pox, Tetanus, Hepatitis B and so on. So, as a long time Obamacare (healthcare marketplace insurance plan) holder, I finally decided to get a PCP (primary care provider) in a health center near me (Dimock Center in Roxbury/Jamaica Plain) and schedule my annual exam.

In the first visit, the doctor did a usual physical examination and ordered some blood tests for STIs and all the immunizations my new rotation required. Two weeks later, the bloodwork was billed to my insurance and denied. I was hit with a $740 bill. It was shocking and honestly, a bit traumatizing to see that. I did not want to really think about it but I went into the health insurance portal to look at what was itemized and what the bill was mostly for. It was for all the blood tests done in Beth Israel Hospital.

I called BMC Healthnet to inquire, the first agent told me she would send my request for a claims review and I have to wait 2 weeks before calling back. The next day, I had another call with an agent and he explained that even though all the bloodwork was considered Preventative Healthcare and should be fully covered, it was done by an out-of-network hospital. I needed to ask the blood draw nurse before they sent it to any lab. Or they have to do some admin work to bill it correctly through the health center that I was at (in-network.)

So, what did I learn in this journey? Always call your insurance plan to make sure your provider is in-network and what you plan to do in your visit is fully covered and you can ask for an estimate of your co-pay or the visit. If you have a high deductible plan, this is crucial to make sure you don’t get a surprise health care bill. And if your PCP is requiring blood work, always ask them to tell you which lab is doing the tests and call your insurance plan again to confirm that they will be paying those labs.

Always call your insurance before any protocol, any visit and if you need prior approval note from your PCP for a specialist visit to be covered, make sure you communicate with the PCP and specialist (Of course, make sure the specialist is also in-network.)

Do not panic when you get a surprise bill, breathe, call your insurance, understand why it was denied, sometimes there are errors and they can work with your PCP to rectify or negotiate the bill down.

Do not rush to pay any healthcare bill, there is a new law that guarantees that health bill cannot hit your credit history until 180 days after it is finalized and due. There is legislation progress around protecting people from shocking health bills.

Lastly, prevention is the best cure, use your insurance, do your annual examinations however awful or scary they may feel, screenings detect health issues early on so you can treat everything early on. Your health is the foundation for a solid, safe, fulfilling life, so prioritize it and have your insurance card and their number on hand.

My plan: BMC HealthNet QHP plan Bronze

Their phone number: 6177486000

My PCP health center: Dimock Center and Dr. Majorie Janvier

I truly love and appreciate them for their support on my health.