Insurance Guidelines

Orthopaedic Associates requests that you familiarize yourself with the rules and regulations of your insurance policy. The rules concerning insurance procedures are subject to change, and we remind you of the following:

When your insurance states that you need a referral, it is your responsibility to obtain a referral from your primary care physician PRIOR to your visit with our specialist. We must have the referral in our office by the time of your appointment, or we will have to reschedule your appointment for a later date. Insurance contracts do not allow retroactive referrals anymore. Failure to adhere to the above procedure will deem any specialist appointment you make your own financial responsibility.

You must be certain that our specialist you are going to see is listed as a provider on your insurance plan. It is essential that you complete the following steps for any specialist you are going to see:

• Check your insurance directory
• Check with your primary care physician’s office
• Call your insurance company

Upon seeing one of our specialists, you must also contact your insurance company if any of the following are prescribed or ordered by our physicians to determine if prior authorization is required:

• Physical therapy and/or occupational therapy
• Diagnostic testing (MRI, bone scan, CT scan, blood work, etc.)
• Durable medical equipment (braces, etc.)
• Referral to another specialist for a second opinion and/or treatment
• Pain management, epidural blocks, etc.

Failure to contact your insurance company regarding any of the above may result in your insurance company denying payment for services rendered. It is important that you present your current insurance card when you arrive at our office. Your insurance card contains vital information we must have to properly submit and process your claim. If you have a co-payment, your insurance company requires that you pay at the time of your office visit.

Please call our office at (440) 892-5337 if you have any questions. These guidelines are presented in order to help us help you. Thank You!

At Orthopaedic Associates, we accept the insurance plans listed below:

• AETNA
  • Traditional
    • All Aetna traditional products
    • Aetna HMO (Referral Required)
    • Geha is now Aetna
  • Medicare
    • Aetna Medicare Advantra HMO
    • Aetna Medicare HMO (Referral Required)
    • Aetna Medicare Premier HMO (NO Referral Required)
    • Aetna Assure HMO SNP (Referral Required)
    • Aetna Medicare PPO
    • Aetna Medicare Advantra Silver Medicare PPO
    • Aetna Value Plan HMO (Referral Required)
•  ANTHEM
  • Traditional and Medicare
  • Pathway X HMO
  • DO NOT PARTICIPATE WITH MEDCAID (Paramount)
• ASSURANT HEALTH / SOME NETWORKS ONLY
• BANKERS FIDELITY INSURANCE
• BEECH STREET (aka Multiplans / PHCS)
• CARESOURCE MEDICAID
  • Care Source Medicaid
  • Care Source My Care Plan
  • Care Source Medicare Advantage (2017)
  • VA PCCC Program
  • Caresource Silver, Bronze and Gold Market Place
• CIGNA
• CLARITY HEALTH
• CORESOURCE
• COFINITY
• COVENTRY (not Medicare Advantage/PPO AKA Advantra Medicare)
• CHAMPVA
• DEVOTED HEALTH MEDICARE
• ENTERPRISE GROUP PLANNING
• FIRST HEALTH NETWORK
• GEHA - AETNA
• GOLDEN RULE AKA UNITED HEALTH CARE
• GREAT WEST AKA CIGNA
• HEALTH SMART (aka United Food & Commerical Workers - AKA Local 880))
• HUMANA
  • 2 Commercial Plans
    • Choice Care Network
    • Humana PPO
  • 5 Medicare Plans
    • Medicare HMO
    • Medicare PPO
    • Medicare Private Fee for Service
    • Humana Cleveland Clinic Medicare Advantage Preferred HMO (NO Referral Required)
    • Humana Cleveland Clinic Preferred HMO SNP
    • Humana Gold Plus HMO Medicare
• HIGHMARK AKA ANTHEM
• LHI - LOGISIC HEALTH INSURANCE (SMITH)
• LUMENOS, INC AKA ANTHEM
• MEDICAID
• MEDICAL MUTUAL
  • Super Med PPO & HMO
  • Medicare Advantage (NO Referral Required)
  • North East Ohio HMO
  • HMO Health Ohio
  • Mercy PPO
  • Mercy Choice
  • Mercy Health HMO
  • MedFlex Network; Narrow Selected Network
  • Northern Ohio HMO Network
• MERITAIN - Aetna
• MUTUAL HEALTH SERVICES - CLEVELAND CLINIC EMPLOYEE HEALTH PLAN (OAI is a Tier 1 Provider)
• MEDICARE
  • Anthem Mediblue Medicare
  • Anthem Mediblue Prime Select (HMO) Cleveland Clinic product
  • AARP Medicare Complete PPO
  • AARP Medicare Complete HMO
  • Aetna Medicare (Referral Required for the HMO product)
  • Aetna Medicare Advantra Silver PPO & HMO
  • Caresource  MyCare Medicare
  • Evercare Medicare Pacific Care
  • Devoted Health Medicare
  • Humana Medicare
  • Medical Mutual Advantage Medicare
  • Railroad Medicare
  • UHC Secure Horizons
  • Summa Care Medicare
  • Humana Cleveland Clinic HMO - (NO Referral Required)
  • Humana Gold Plus HMO Medicare
• MULTI PLANS / PHCS NETWORK
• NATIONWIDE HEALTH PLANS
• OHIO CARPENTERS HEALTH AND WELFARE FUND (AKA MEDICAL MUTUAL)
• OHIO HEALTH CHOICE (AKA Preferred One, AKA Ohio PPO Connect)
• OSCAR - Cleveland Clinic Market Place Plan
• PHCS PRIVATE HEALTHCARE SYSTEMS (AKA Multiplan, AKA Meritain)
• RAILROAD MEDICARE
• SALVATION ARMY
• SUMMA CARE HEALTH PLANS
  • SC Medicare
  • SC Premiere
  • SC Prime
  • SC Prime Tiered
  • Mercy Choice
  • SC Premiere Fully Funded - Summa care employee's and Mercy employee's
• THE HEALTH PLAN
• TRICARE
  • Tricare East
  • Tricare Select
  • Tricare Reserve Select
  • Tricare Retired Reserve
  • Tricare for Life
  • Tricare Prime (Referral Required from PCP or PCM)
  • Tricare Prime Remote (Referral Required)
  • Tricare Young Adult Prime (Referral Required)
  • ChampVA  (Dependents of veterans who have a 100% disability received while on active duty or dependents of veterans who died from a disability received while on active duty)
• UNITED FOOD
• UNITED HEALTH CARE
  • All Savers
  • UMR
  • Golden Rule
  • Sierra Health & Life Ins
  • Select Plus
  • Oxford Health Plan
  • Secure Horizon (Medicare)
  • Evercare Medicare Pacific care (Medicare)
  • AARP Medicare Complete PPO
  • AARP Medicare Complete HMO
  • Secure Horizon's (Medicare)
  • Navigate Plus (Referral Preferred - more out of pocket cost without a referral)
  • Community Plan - Dual Complete HMO SNP
  • UHC - Walgreens (Requires Referral)
  • Community Plan Medicaid
  • MyCare Ohio Community Plan
  • Nexus Acco (Requires Referral)
  • UHC Silver Advantage Group (PCP referral required)
• UNITED AMERICAN
• VA CHOICE
  • VA PCCC (Caresource)