We accept all Medicare, Medicaid and Traditional Insurances. We also participate in several PPO and HMO plans.
FAQ's - Frequently Asked Medicare Questions
- What is the Medicare Deductible and what does it mean to me?
- What does Medicare mean when they refer the to "Approved Amount"?
- Will Medicare always pay the Approved Amount?
- What about charges that Medicare does not cover in full?
- Can I join an HMO or Medicare Advantage plan if I have Medicare?
- Will I be responsible for submitting my own insurance claim?
- In what insurance plans do you participate?
- If I need a referral, what should I do?
We would like to give our assurance that all questions will be handled in a prompt and professional manner. Please feel free to contact our Billing Department with any questions you may have. Our staff is available to you Monday through Friday from 10:00 am to 2:00 pm and can be reached by phone at (216) 451-2030.
Click here for more information about Medicare.
What is the Medicare Deductible and what does it mean to me?
The Medicare Deductible is equal to $147.00. Simply put, Medicare says the patient is responsible for the first $147.00 in medical expenses (excluding laboratory testing and some diagnostic testing). The deductible is assessed annually and includes all services from providers received on a first come first serve basis. Laboratory tests and diagnostic tests are paid at 100% from the first day of the year. Remember, the Medicare deductible is assessed annually, you will be responsible for the first $147.00 every year beginning January 1.
What does Medicare mean when they refer to the "Approved Amount"?
Your provider will submit an insurance claim to Medicare listing the services provided and the amount charged for each of these services. In processing this claim, Medicare will compare these amounts to a fee schedule consisting of the "usual and customary" fees charged by like practices in the area. This fee is the approved amount. If the provider is a participating-provider, he can charge no more than the Medicare approved amount.
Will Medicare always pay the Approved Amount?
Medicare will pay 100% of the approved amount on many medical expenses. As explained above, Medicare will pay 100% for lab tests and some diagnostic tests. However, for an office visit Medicare pays only 80% of the approved amount leaving 20% as the patient's responsibility. Please remember that the $147.00 deductible rule precedes any payment. At the beginning of any given year, the first charges of that year will be applied to the deductible before Medicare will make any payment to your provider with the exception of lab and some diagnostic testing. If you have any doubts regarding coverage or your current deductible remaining, please contact Medicare directly to verify this information. The phone number for members can be found in your local Yellow Pages and representatives are available during regular business hours.
What about charges that Medicare does not cover in full?
As stated above, Medicare does not always cover everything. In addition to the 20% not covered by Medicare for an office visit, Medicare will also assess a 20% patient co-payment on services rendered to you by your doctor while you are a patient in the hospital or a skilled nursing facility. Many people have opted to purchase supplemental, or Medigap, insurance to cover these expenses. This is additional insurance purchased separate from Medicare and paid entirely by the patient. You should carefully consider what your medical needs are and what they may be in the future to determine if secondary insurance is something you want to consider.
Can I join an HMO or Medicare Advantage Plan if I have Medicare?
There are many plans that offer coverage to those who currently are on the standard Medicare policy. Most Medicare Advantage Plans provide single insurance coverage with no need to purchase a supplemental policy. They may not assess a deductible. However, please keep in mind, if you join a Medicare Advantage Plan, your care should be coordinated through your PCP (Primary Care Physician). As a member, you may be asked to choose a physician to act as your PCP. The PCP will be responsible for your general healthcare and will determine if and when it is necessary for you to see a specialist. It may be necessary to issue a referral if for you to have services provided outside of our office. Any services provided without a referral from your PCP may not be honored by the insurance plan and will be your full responsibility. Each plan has a network of providers that participate in that particular insurance. Before signing on, check to see if your family physician, local hospital and any specialists you are currently seeing are part of that network.
Will I be responsible for submitting my own insurance claim?
All physicians participating in Medicare and Blue Shield programs are required by law to submit claims on behalf of their patients. For those patients that have coverage through other insurance companies, we will also submit claims on your behalf. You must realize, however, that the insurance contract is between you and your insurance company and any balance remaining after your insurance has paid will be your balance.
In what insurance plans do you participate?
Brown Medical Center is currently a participating-provider with:
- Aetna - Choice POS II
- Aetna HMO
- Anthem Blue Access PPO
- Anthem Blue Preferred HMO
- Blue Cross and Blue Shield - BlueCard PPO
- Cigna - Open Access
- Cigna HMO
- Cigna PPO
- First Health PPO
- Great West Healthcare PPO
- Humana - Choice Care PPO
- Medicaid - All Current Ohio Plans
- Medical Mutual of Ohio
- Medicare (General)
- MultiPlan - PHCS PPO
- MultiPlan PPO
- Mutual of Omaha
- Principal Financial
- United HealthCare
- United HealthCare - Choice Plus POS
- United HealthCare - Options PPO
- WellCare Health Plans
and several others. New Insurances are added daily so if you have any doubts, please contact us. Or, you can call your insurance company and confirm the name of the provider you are inquiring about along with the current address and phone number, to ensure participation.
If I need a referral, what should I do?
If you have an upcoming appointment for which you need a referral, you must call our office to speak to our referral coordinator. You may speak directly with the coordinator, or you may be asked to leave a message on voice mail. In either case, you will be asked to leave information regarding the nature of the services for which you are requesting a referral. This information will consist of the name of the physician you will be seeing, the date and time of your appointment, and the reason for the appointment.
This information is then given to your PCP for approval. Once we get PCP approval the referral will be issued. Most referrals are entered into an electronic system linked directly to the insurance company thereby eliminating the need for you to come to our office. There may be times when this is not possible and you may need to stop by to pick up a paper referral before your scheduled appointment. Due to the overwhelming number of requests, we ask at least five days notice in order to complete the paperwork necessary to establish a referral. Remember, if the referral is not done, you will be responsible for the charges.