Each time you visit us, please bring a photo ID and your current insurance card with you. Please check in at the self kiosk and or at the front desk and present your Insurance Card and valid ID. If you have a co-pay or a past due balance you will be able to make your payment at this time.

• New Patient Registration Form
• Insurance Card
• Previous Records
• Your Prescription Bottles
• Translator if needed
• Questions

New Patient Registration Form

Phone: 508-303-8553
Email: info@marlborointernalmedicine.com
Web: www.marlborointernalmedicine.com

Office Hours
Monday: 7:30 AM – 5:00 PM
Tuesday: 7:30 AM – 5:00 PM
Wednesday: 7:30 AM – 3:00 PM
Thursday: 7:30 AM – 5:30 PM
Friday: 7:30 AM – 4:00 PM
Several times throughout the year we offer Saturday appointments from 8:30 AM – 11:00 AM.

After Hour Calls
Our providers or their assistants are on call 7 days a week 24 hours a day.

To reach our providers after hours or to see who is covering for him, please call our answering service at 508-303-8553. If you do not receive a call back in 10 minutes, please call again.

If you have symptoms that you think may be life threatening, including concerns about chest pain or stroke, please call 911 or go to the nearest emergency room. Otherwise, the answering service will page the provider when the office is closed for urgent medical matters that cannot wait until the next business day.

Please respect your providers off hour’s time by calling only for urgent medical matters, not prescription refills, referrals, etc… If you page the provider and do not receive a return call within 30 minutes, call the office and have the provider paged again.

Directions

For sick visits, please call early morning in order for us to get you in same day.

For any changes to your appointment, a 24-hour advanced noticed is necessary for our office to provide optimal service to all our patients. A $25.00 cancellation-no show fee will be assessed if an appointment is missed or cancelled without adequate notice. If you repeatedly miss appointments without calling, we may choose to not continue to see you. If you are 15 minutes or more, late for an appointment, we may ask you to reschedule.

Arrive 5-10 minutes before your appointment so insurance matters can be addressed by the receptionist. Please bring your insurance card on every visit.

All payments are expected at the date of service. We are often able to work out special payment plans for patients with extenuating circumstances.

At this time we DO NOT accept the following insurance plans (last updated January 2018):
• Fallon Direct
• Fallon with Mass Health
• Celticare
• Harvard Pilgrim Focus
• Health Safety Net
• BMC
• AARP Medicare complete
• Tufts Health Spirit Plan
• Tufts Medicare Preferred HMO

For further assistance regarding insurance or billing please contact our office at 508-303-8553 between the hours of 9:00am and 3:00pm Monday, Tuesday, Thursday and Fridays. Existing patients who are web-enabled may also contact us regarding billing via their Patient Portal account.

Proof of Insurance
Please present your valid insurance card at each visit. If your claim is rejected due to incorrect insurance or coverage not in effect, then you are responsible for the charges. If we are unable to verify your insurance at time of visit, you are considered a Self Pay and you are responsible for payment at time of the visit.

Co-Payments and Deductibles
Co-pays are due at time of appointment. It is your responsibility to know your insurance plan. All co-insurance, deductibles, and non-covered expenses will be paid in accordance with our office policies.

Claims Submission
We will submit claims on your behalf to your insurance company for payment. Your insurance company may require that you supply certain information directly. It is your responsibility to coordinate your benefits with your carrier. Please be aware that the balance of your claim is your responsibility whether or not your insurance company pays your claim.

Coverage Changes
If your insurance changes, please notify us before your next visit, so we can update your insurance information in our system. Providing us with this information prior to your visit will reduce your wait time. We will also do our best to verify your insurance coverage prior to your visit to minimize surprises at the time of visit.

Accident & Workers Comp
Although our office is happy to treat your medical conditions, if the cause is auto or work related, we ask that you fill out a form with specific information to an open claim.

The relationship between the provider and patient is confidential and any information exchanged will be held in the strictest of confidence. Confidential medical information will be released only with the express consent and authorization of the patient.

NOTICE OF PRIVACY PRACTICES

To complete your request, we will need the following information:

• Patient’s name and date of birth
• Caller’s name and phone number
• Patient insurance and identification number
• Name of the specialist or facility along with NPI number
• Reason for visit and date of appointment
• Phone and FAX number

We will submit all the required information to the insurance company, but it is up to your insurance company to decide if the referral is approved.