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
  • POS
  • PPO
  • Select Open Access
  • Choice II
  • Open Choice PPO
  • CHoice POS II
  • Manage Care Open Access
  • HMO (Requires Referral)
  • MEDICARE - AETNA MEDICARE PPO (does not require referral)
  • MEDICARE - AETNA MEDICARE HMO (Requires Referral)
• ANTHEM
  • Anthem Federal
  • Anthem MediBlue (formerly: Anthem Senior Medicare Advantage)
  • Anthem MediBlue Medicare
  • BC/BS – Out of State
  • Community Choice
  • Freedom Blue Medicare
  • Highmark
  • PPO
• APEX (UNIVERSITY HOSPITAL EMPLOYEE HEALTH PLAN; OAI is a tier 1 provider)
• ASSURANT HEALTH / SOME NETWORKS ONLY
• BEECH STREET (aka Multiplans / PHCS)
• CARESOURCE MEDICAID
• CARESOURCE MY CARE OHIO
• CARESOURCE MEDICARE ADVANTAGE
• CIGNA
• CORESOURCE
• COFINITY
• COVENTRY (not Medicare Advantage/PPO AKA Advantra Medicare)
• CHAMPVA
• EMERALD HEALTH NETWORK AKA UNITED FOODS
• FIRST HEALTH NETWORK
• GEHA (Government Employees Hospital Association)
• GOLDEN RULE AKA UNITED HEALTH CARE
• GREAT WEST AKA CIGNA
• HEALTH SMART (aka Emerald Health Network)
• HEALTH SPAN
• HUMANA
  • Choice Care Network
  • Humana PPO
  • Medicare HMO (Requires referral)
  • Medicare PPO
  • Medicare Private Fee for Service
• HIGHMARK AKA ANTHEM
• LUMENOS, INC AKA ANTHEM
• MEDICAID
• MEDICAL MUTUAL
  • Medical Mutual Market Place
  • Medicare Advantage (does not require a referral)
  • Super Med
• MEDICARE
  • AARP Medicare Complete PPO
  • AARP Medicare Complete HMO (Requires Referral)
  • Aetna Medicare (Requires Referral)
  • Anthem MediBlue Medicare
  • Care source Medicare
  • Evercare Medicare Pacific Care
  • Freedom Blue Medicare
  • Healthspan Medicare Plus HMO
  • Humana Medicare (Requires Referral)
  • Medical Mutual Advantage Medicare
  • Railroad Medicare
  • Summa Care Medicare
  • UHC Secure Horizons
• MUTUAL HEALTH SERVICES (CLEVELAND CLINIC EMPLOYEE HEALTH PLAN; OAI is a tier 1 provider)
• MULTI PLANS / PHCS
• NATIONWIDE HEALTH PLANS
• OHIO CARPENTERS HEALTH AND WELFARE FUND AKA MEDICAL MUTUAL
• OHIO HEALTH CHOICE (aka Preferred One)
• PARKER HANNIFIN AKA SUMMA CARE
• PHCS PRIVATE HEALTHCARE SYSTEMS AKA MULTIPLAN
• RAILROAD MEDICARE
• SALVATION ARMY
• SAMBA AKA CIGNA
• SUMMA CARE HEALTH PLANS
  • SC Medicare
  • SC Premiere
  • SC Prime
  • SC Prime Tiered
  • SC Select
  • Mercy Choice
  • Community Choice
  • SummaCare Medicare Topaz (HMO)
  • SummaCare Medicare Ruby (HMO)
  • SummaCare Medicare Sapphire (HMO-POS)
  • SummaCare Medicare Emerald (HMO-POS)
• TRICARE
  • ChampVA
  • Tricare Standard
  • Tricare Extra
  • Tricare Reserve Select
  • Tricare Retired Reserve
  • Tricare for Life
  • Tricare Prime (Requires Referral from PCP or PCM)
  • Tricare Prime Remote (Referral Required)
  • Tricare Young Adult Prime (Referral Required)
• UNITED AMERICAN
• UNITED FOOD (aka Emerald Health)
• UNITED HEALTH CARE
  • AARP Medicare PPO
  • AARP Medicare HMO (Referral Required)
  • All Savers
  • Evercare Medicare Pacific Care (Medicare)
  • Golden Rule
  • Navigate Plus
  • Oxford Health Plan
  • Secure Horizon (Medicare)
  • Sierra Health & Life Ins
  • UMR