Medical Insurance

To help you better understand your financial responsibility for the services provided by Mayfield physicians and nurse practitioners please review our Patient Financial Responsibility Policy [PDF download].

Depending on whether you have insurance, and the extent of your coverage, you may be asked to make a payment at the time of your visit. We suggest that you contact your health insurance  plan before your appointment to verify benefits and coverage and to confirm that your Mayfield physician is a participating provider.

Is my Mayfield provider covered by my insurance plan?

To find out if Mayfield is a participant in your healthcare insurance plan, you will need to call the phone number on your insurance card. If requested, Mayfield's Tax ID number is 31-0588183.

Insurance Plans

Mayfield is a participating provider with most major insurance plans:

  • AARP Medicare Complete
  • Aetna
  • Anthem
  • Buckeye Health Plan
  • Care Source
  • Cigna
  • Direct Care America/Primary Health Services (DCA/PHS)
  • Gateway Health
  • Healthsmart (IHG)
  • Humana
  • Kentucky Medicaid
  • Medical Mutual
  • Medicare
  • Medigold
  • Molina
  • Ohio Health Choice Plan (OHCP)
  • Ohio Health Plan/Great West
  • Ohio Medicaid
  • TriCare
  • United Healthcare
  • Wellcare of Kentucky
  • Wellcare of Ohio
  • Workers' Compensation (Kentucky)
  • Workers' Compensation (Ohio)

If you don’t see your insurance plan listed, you can contact us to verify whether we participate with your plan.

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. In these cases, you shouldn't be charged more than your plan's copayments, coinsurance and/or deductible.

What is "balance billing" (sometimes called "surprise billing")?

When you see a doctor or other healthcare provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, and/or a deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn't in your health plan's network.

"Out-of-network" means providers and facilities that haven't signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called "balance billing." This amount is likely more than in-network costs for the same service and might not count toward your plan's deductible or annual out-of-pocket limit.

"Surprise billing" is an unexpected balance bill. This can happen when you can't control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You're protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan's in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can't be balance billed for these emergency services. This includes services you may get after you're in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Ohio law is consistent with the above.  For emergency services provided by an out-of-network provider or out-of-network facility, the cost-sharing amount cannot be greater than if the services were provided in network.

 

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan's in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can't balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other types of services at these in-network facilities, out-of-network providers can't balance bill you, unless you give written consent and give up your protections.

You're never required to give up your protections from balance billing. You also aren't required to get out-of-network care. You can choose a provider or facility in your plan's network.

Ohio law is consistent with the above. In addition, under Ohio law, out-of-network providers and out-of-network facilities are prohibited from balance billing you for clinical laboratory services provided in connection with any unanticipated or emergency out-of-network care.

When balance billing isn't allowed, you also have these protections:

You're only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.

Generally, your health plan must:

  • Cover emergency services without requiring you to get approval for services in advance (also known as "prior authorization").
  • Cover emergency services by out-of-network providers.
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
  • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If you think you've been wrongly billed, contact: Ohio Department of Insurance: insurance.ohio.govconsumer.complaint@insurance.ohio.gov, and 1-800-686-1526. The federal phone number for information and complaints is 1-800-985-3059.

Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law. Visit Suprise billing toolkit for more information about your rights under Ohio state law. 

Under the law, health care providers need to give patients who don't have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
  • If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1- 800-985-3059. 

Payments
Your co-payment, co-insurance and deductible are due at the time of your visit.  If you require surgery, a payment request may be made prior to scheduling. For your convenience, Mayfield accepts cash, personal checks, and most major credit cards.

Please remember to bring your insurance card, Medicare or Medicaid card with you to your office visit. If you do not bring your card, we will ask that you pay at the time of your visit.

Health Plan or Managed Care Plan
If you are enrolled in a health plan or managed care plan, your co-payment will be collected before you see the doctor.

Medicaid/Managed Medicaid
If you are enrolled in a Managed Medicaid plan, your co-payment will be collected at the time of your visit. No payment is required for traditional Medicaid. A physician referral is required for both Medicaid and Managed Medicaid patients.

Medicare/Managed Medicare
If you are enrolled in traditional Medicare, 20% co-insurance will be collected at the time of your visit. However, if you have secondary coverage to Medicare, no payment is required.

If you are enrolled in Managed Medicare, your copayment will be collected at the time of your visit.

Workers' Compensation and Self-Insured Employer
If you are being seen for a work-related injury, your claim must be approved by the Bureau of Workers' Compensation or self-insured employer.

If approved, please provide the following information: date of injury, claim number, the name and billing address of the managed care organization that administers your benefits, and the name of your treating physician.

If your claim is pending or not approved, Mayfield will submit a claim to your health insurance company. If you do not provide your workers' compensation claim number, and you do not have health insurance, we will ask that you make payment at the time of your visit.

Out-of-Network Insurance
If Mayfield Clinic is not  a participating provider with your insurance plan, we will assist you in obtaining benefits from your insurance company, but ask that you make payment at the time of your visit.

No Insurance
If you do not have health insurance, we ask that you make payment at the time of your visit. Please contact Mayfield's financial coordinators at 513-569-5300 if you have questions.

Refunds
If you have any questions concerning a refund on your account, please contact Mayfield's Patient Accounting Department at 513-569-5300 or 800-325-7787.


 



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To learn more about their low interest or no interest payment plans, visit www.CareCredit.com or contact one of our financial coordinators at 513-569-5300.


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