Patient Resources

New Patient Forms

• Medical History Form
• Patient Financial Policy & Notice of No Show/Late Cancellation Fee Form
• Assignment of Benefits Form
• Communication Consent Form (optional)
• Permission to Treat Minors (if applicable)
• Notice of Privacy 

Other Patient Forms

• Permission to Treat Minors
• Release of Medical Information
• Short-Term Disability Consent Form
• Baby Photo Authorization Form
• Emerson Hospital Birth Certificate Registration
• Communication Consent Form

Billing & Insurance

• Patient Financial Policy
• Contact our billing department at 978-371-0302 x 202
• We accept most major insurance plans including the following:
  • Aetna
  • Blue Cross Blue Shield
  • Cigna
  • Fallon with Atrius ACO
  • Harvard Pilgrim Healthcare
  • Mass General Brigham Health Plan
  • MassHealth
  • Medicare
  • Tricare
  • Tufts
  • Tufts Public Plan
  • United Healthcare
  • HMA Administrators
  • PHCS

Laboratory Services at Concord OB/GYN

Laboratory services are provided by Emerson Hospital for your convenience on site at Concord OB/GYN.  All lab work (excluding genetic testing), cultures, pap smears, urine and pathology specimens are processed by Emerson Hospital who will submit a claim to your insurance for the processing of your specimen.

Genetic Testing - Natera

 At Concord OBGYN, we partner with Natera for a range of genetic tests, including:

• Panorama® NIPT
• Horizon® Carrier Screen (14 Panel & Expanded Panels)
• Vistara™ Single Gene NIPT
• Fetal Focus™ NIPT
• Empower® Hereditary Cancer Test

1. Once your specimen arrives at Natera’s lab, they will check your insurance and estimate your cost.
2. If your estimated out-of-pocket cost is higher than Natera’s self-pay price (typically $249 or $349, depending on the test),
   Natera will contact you by email and text with a detailed cost estimate and payment options.

Typical Self-Pay Prices

• Most tests: $249 per test
• Expanded panels or specialized tests: Up to $349 per test

• You may receive an Explanation of Benefits (EOB) from your insurance company showing the claim as denied → This is not a bill.
• If a claim is denied, Natera will appeal on your behalf.
• If the appeal is unsuccessful, Natera will bill you the discounted self-pay rate ($249 or $349), depending on the test ordered.
• If your insurance applies the claim to your deductible or coinsurance, the self-pay price does not apply.

Questions or Billing Assistance

If you have questions about your bill or cost estimate:

• Contact Natera Billing:
  Tel: 844-384-2996
• Email: patientsuccess@natera.com (include your CASE ID in the subject line)
  or visit www.natera.com/womens-health/pricing
• If you still have unresolved concerns after contacting Natera, please reach out to:
  Kristin at Concord OBGYN
  Tel: 978-371-0302 ext. 204

Ultrasound Services at Concord OB/GYN

For your convenience, ultrasound services are performed by a Premier Ultrasound Services certified sonographer and are available on site in our Concord & Westford office locations. 

All ultrasounds are billed in two parts:

The technical component (TC) includes all costs related to the performance of the procedure itself, such as the ultrasound machine, supplies, and the sonographer's services. It is the part of the bill that covers the facility and equipment (not the physician's professional interpretation and report, which is billed separately).  Concord OBGYN will submit a claim to your insurance for the technical component of your ultrasound.

The professional component (PC) refers to the reading radiologist’s services, including interpretation of the images and a written detailed report.  The reading radiologist will submit a claim to your health insurance for the professional component of your ultrasound.

• Pelvic Ultrasounds are read by Dr. David Rose of North Bridge Imaging Group LLC
• Obstetrical Ultrasounds are read by Dr. Tamara Takoudes of Boston Maternal Fetal Medicine (MFM)

Should you receive a bill for their services, we ask that you please contact them directly for any questions surrounding your bill.

• Boston Maternal Fetal Medicine: 617-264-0364
• North Bridge Imaging Group LLC: 978-243-4205

Helpful Links

• ACOG.org - for Patients – American Congress of Obstetricians & Gynecologists
• Mothertobaby.org - A trusted source of evidence-based information on the benefit or risk of medications and other exposures during pregnancy and while breastfeeding
• EmersonHealth - Find Help - Find information about financial assistance, food pantries, medical care, and other free or reduced-cost services in your area.
• Women, Infant & Children Nutrition Program (WIC) - A Massachusetts nutrition program that provides healthy foods, nutrition education, breastfeeding support, and referrals to healthcare and other services, free of charge, to Massachusetts families who qualify.
• FirstConnections.org – A non-profit, family support organization providing comprehensive services to families with infants & young children in metro-west communities.
• ImmunizationForWomen.org – Flu Season Immunizations
• La Leche League – Breastfeeding support & information for mothers
• Mayoclinic.org 
• Womenshealth.gov – Empowering women to live healthier lives.

Patient Portal

Communicate using our secure patient portal.