Billing Questions

New Billing Software - June 2025

Please be aware that in June 2025, we will be going to a new billing software. There may be some bumps along the way, and we are asking for your patience and understanding. We will still be working out of the current software for a time so you may see two different types of statements.

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.

Click HERE for more information on insurance coverage.

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.

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

Premium - the amount you pay monthly to keep your health insurance active.

Referrals - 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.

Prior Authorization - 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.