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Billing and Insurance

While Retina Associates of Cleveland, Inc is contracted with most common insurance companies (including Medicare, Medicaid, Veterans’ administration and workers compensation), there are some insurance plans that we do not participate with. Please call your insurance company to make sure your provider is in network with your plan. 

The insurance plans we do not participate with are listed below:

AultCare Premium PPO

Only the following physicians and locations are participating:

  • Arnold F. Nothnagel, DO
  • Sean M. Platt, MD
  • Dover and Canton locations ONLY

Medical Mutual

The following is a list of Medical Mutual Plans that we do not participate with:

  • Medical Mutual CLE-Care HMO
  • Medical Mutual Lake Health
  • Medical Mutual MetroHealth
  • Medical Mutual Ohio Health Network
  • Medical Mutual SkyCare MetroHealth

Paradigm (Core Care)

Non-participating providers:

  • Lediana Goduni, MD
  • Hang Pham, MD
  • Scott D. Pendergast, MD
  • Llewelyn J. Rao, MD
  • Lawrence J. Singerman, MD, FACS
  • Shawn C. Wilker, MD

UHC Nexus ACO HMO

Referrals are required. Non-participating providers:

  • Thomas P. Hull, MD
  • Arnold F. Nothnagel, DO
  • Thomas J. Tsai, MD

UPMC

  • Joseph M. Coney, MD, FACS (only participating provider)

Billing Questions

How do I know if I’m covered?

While you’re in our office, you may be told a certain procedure is covered. This does NOT necessarily mean that it will be covered at 100%. What it means is that your health plan will cover their portion, however you may incur costs depending on where your deductible and out of pocket stand. We are not privy to this information and cannot predict if a cost/fee will be incurred. Please contact your insurance company.

Statement Questions

If you have any questions about your statement, our billing office is always happy to help. However, since we have no control over how your insurance company adjudicates your claim, it may be beneficial to call them first and ask how the claim was processed. If you still have questions after speaking with your insurance company, please call our billing office at (216) 831-5704.

Good Days Funding

Please be aware that those of you who had Good Days Copay assistance, Good Days has lost their funding and are no longer paying the co-pay on your injectable drugs.

Insurance Terms:

Copay is a set fee that must be paid at the time of service. It is applied to the office visit. In some cases when an office visit is not charged, your insurance company may apply your copay to a diagnostic procedure. This is solely at the discretion of your insurance company.

Coins is the amount you pay after you meet your deductible. This is usually a percentage. Such as 20% for example.

A deductible is the amount you need to spend for eligible healthcare expenses before your insurance kicks in.

If you belong to a PPO or HMO, you’ll probably need to see your Primary Care Provider  first. If they agree that you need to see a specialist, they will refer you to an appropriate one. Some health plans require a referral in writing, while others will accept a phone call. It is the responsibility of the referring physician to obtain the referral, not the specialist.

After you have seen one of our specialists, it may be determined that a procedure is necessary, and prior authorization must be obtained. It is the responsibility of our physicians to ensure that one is obtained.

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