Insurance & Billing
What is a Co-pay?
A co-pay is the dollar amount you are responsible for paying before every office visit, if required by your insurance policy. Insurance companies also use the term co-pay to refer to a balance that may incur after they have determined payment/or non-payment of a claim. This is also called the patient balance.
How long until my insurance company responds to a claim? How do I know what my insurance is covering?
It takes approximately 21 days for an insurance company to respond to a claim once your doctor’s office has submitted coding from your visit. You will receive an Explanation of Benefits (EOB) in the mail explaining what your insurance will/will not cover. This will help determine if and why you have a patient balance owed to your doctor. If you get your EOB and have any questions about what your insurance is or is not covering, please contact your insurance company. Most large insurers have many plans and thousands of combinations of coverage benefits. Only a discussion of your exact policy with your insurance company will determine what is being covered. Your patient statement balance from Retina Center of Ohio will not be generated until the EOB from your insurance company dictates what is owed. If there is something we can do to help, please let us know.
How is a patient balance determined?
A patient balance is determined by the insurance company. Each insurance company reviews the charges submitted and then determines what amount is allowed. This is presented to you, as the patient, in something called an Explanation of Benefits (EOB). This will be mailed to your home by your insurance company. An EOB can be easily recognized by the statement on the top: “This is not a bill”.
Why do I have a patient balance?
The number one reason for a patient balance is when an insurance deductible is owed on your policy. Once the deductible is met, then your services are usually covered according to the percentage of coverage determined by your insurance plan. Most people have deductibles to allow the monthly cost of insurance to be lower. The second reason for having a patient balance is when the insurance company dictates there is a co-payment amount due after they pay their percentage. The third common reason is when the provider is out of network and your insurance plan does not include “out of network benefits”. It is the patient’s responsibility to contact his/her insurance company, prior to scheduling an appointment, to confirm his/her doctor is in network. If his/her doctor is not in network, the patient must verify if his/her policy has "out of network benefits.” The fourth most common reason for having a balance is if your insurance denied paying the claim and states that the entire balance is your responsibility. If you are unsure of what you owe, please contact our billing office, after receiving a patient statement from “Retina Center of Ohio".
Does Retina Center of Ohio offer payment plans?
In order to serve our patients well, we do offer several payment plan options. Please call us (216) 382-3366 and ask for the billing department to discuss payment options.