Primary care doctor who's not part of a hospital system

[boblothrope.livejournal.com]

Can anyone recommend a primary care doctor whose practice is not part of a hospital system?

Due to a quirk in my insurance, it's a lot more expensive for me when a visit generates two separate insurance charges (one for the doctor and one for the facility). Practices that are part of a hospital system, like Cambridge Family Health North, bill this way even if they're not physically located in a hospital.

Is Somerville Famliy Practice part of a hospital system?

Comments

[junesrose.livejournal.com]

I think the safest way for you to decide which practice will be covered by your insurance is to call your insurance company and ask them for a list of participating providers. You can pick from one of those. I think if you do it on your own, back-assward, it's like playing Russian Roullette.

And, Frankly, I think most doctors HAVE to be part of a hospital system, or else they couldn't refer/send patients to hospitals. Not sure how that works with billing but, just a guess.

Good luck.

[slinkr.livejournal.com]

I don't think the Marino Center in Cambridge (on Mass Ave) bills that way, even though they have an affiliation with Mount Auburn. I only recall getting bills from Mount Auburn when I actually had to go there.

[no1onthecorner.livejournal.com]

I don't believe Somerville Family Practice bills this way, but my insurance doesn't have that quirk so I might not have noticed. I'm pretty sure that when I went in for a physical, I only got one "notification of benefits" piece of paper from the insurance company (while when I had bloodwork done, there was one piece of paper from the office and one from the lab.)

[docorion.livejournal.com]

You ought to ask them to be sure, but my understanding of Somerville Family Practice is that they're a solo practice. Dr. Bershel is affiliated with Mt. Auburn, which means she refers to specialists there (and likely is on the medical staff).

This doesn't (shouldn't) generate a bill for you (it never has for me, and her facility is nowhere near the Mt. Auburn, and is not paid for by Mt. Auburn, so I don't see how Mt. Auburn could justify charging a facility fee).

(I don't know about Cambridge Family Health, but if their building is owned or operated by a hospital system, the hospital can charge an outpatient fee. That would make me cranky, too).

[incandes-flower.livejournal.com]

Somerville family practice is part of the Cambridge Health Alliance. I have no idea how it bills, but it refers to both Cambridge Hospital and Mt. Auburn, so it may not have the same issue. I second the suggestion to check with your insurance company.

[m-b-w.livejournal.com]

Dr. Bershel is at Davis Square Family Practice. Somerville Family Practice is at 1020 Broadway, with Dr. Martin and Dr. Fishman.

[docorion.livejournal.com]

*facepalm*

What m_b_w said.

I knew that.

Thanks for the correction.

[siderea]

Cambridge Family Health North is also CHA, so presumably has the identical problem for the OP.

That said, I used to be at CFHN, and never had separate facility and MD bills. Is this something new?

In any event: Havard Vanguard. Not part of a hospital, despite being big enough to swallow one whole.

[boblothrope.livejournal.com]

Being in-network with my insurance isn't enough.

And a doctor having admitting/referral privileges at a hospital is not the same as visits to that doctor generating facility bills from a hospital.

Re: What insurance

[boblothrope.livejournal.com]

It's an out-of-state Blue Cross plan which I'd rather not name.

[boblothrope.livejournal.com]

I don't see Somerville Family Practice listed at http://www.cha.harvard.edu/locations/locations.shtml . They might have a referral arrangement with CHA, without being a satellite office with billing done by CHA.

Checking with my insurance wouldn't help. They won't tell me what billing codes a doctor's office has submitted for other people.

Even checking with the doctor's office wouldn't necessarily help. In several instances, I've asked doctor's offices in advance how they will bill things, and then they billed it differently leading to much higher costs for me, and it took months to sort it out.

So I'd be most interested in finding a doctor's office that's clearly a standalone operation.