Office Visits
MANAGED CARE -HMO’S: If you are a managed care or HMO (Health Maintenance Organization) patient who requires a referral authorization, it is your responsibility to get this authorization from your primary care physician for new or return office visits. If we do not have an authorization on file at the time of your visit, you will be asked to pay for services rendered, or your visit may be rescheduled. If your insurance covers the office visit or testing, we will submit your claim. If your insurance plan requires a co-payment from you, we will collect this at the time of your visit. We accept cash, check, MasterCard, Visa and Discover. Non-covered services, co-payments or deductibles will be your responsibility.
The Lippy Group for Ear, Nose & Throat ACCEPTS ASSIGNMENT ON MEDICARE. We will submit your claim to Medicare and to your secondary or supplemental insurance.
You will be responsible for the coinsurance amount, which is 20% of the Medicare-Approved Charge, any unmet deductible and all non-covered charges.
Hearing aids are not covered by Medicare. Medicare will NOT pay for any testing of your own hearing aid or tests performed solely to prescribe a hearing aid for you. These costs are your responsibility and will be separately billed.
If you have any questions, please feel free to discuss them with our Business Office staff (330) 856-7585.
Surgery, Hospital and Special Testings
We will verify your insurance coverage and submit to your insurance carrier for these special services. Non-covered services, co-payments or deductibles will be your responsibility.
Medicare and supplemental insurance claims for these special services will be submitted for you.
Forty-five days after we have submitted your claim for special testing or surgical procedures, and payment has not been received in our office, you will be billed and will be responsible for payment.
Our Billing Office will assist you in setting up a payment plan when necessary.
Billing and Credit
Statements will be mailed monthly and are due for payment within 30 days. Monthly statements will follow until the account is paid in full.
If you have any questions, please feel free to discuss them with our Business Office (330) 856-7585.
Medicare Coverage
Medicare does not reimburse in full for medical, office and testing charges or surgical fees. The Medicare payment is approximately 80 % of Medicare’s approved amount less any amount of your unmet yearly deductible.
MEDICARE: Medicare does not reimburse in full for medical, office and testing charges or surgical fees. The Medicare payment is approximately 80% of Medicare’s approved amount less any amount of your unmet yearly deductible. Medicare does not provide coverage for anything having to do with hearing aids, hearing and checks or hearing tests performed for the purpose of hearing aid selection.
BLUE CROSS/BLUE SHIELD: The Lippy Group participates in Blue Cross, Blue Shield plans in Ohio and Pennsylvania. Therefore, claims for services will be submitted by our office and payment will be made to us. Any bill not covered will be the responsibility of the patient.
OTHER INSURANCE PLANS: The Lippy Group participates in the majority of Preferred Provider Organizations. We will submit your claim to the plan for you. Any non-covered services are the responsibility of the patient. Of course, we will need the required authorization and referral forms for each visit.
MEDICAID/WELFARE: The Lippy Group is limited to these programs within the state of Ohio. Also, we will need a valid card verifying coverage. Medicaid HMO’s need referral.
WORKER’S COMPENSATION AND LITIGATION: Our policy is that the patient is responsible for the bill regardless of the case. However, we will cooperate in every way we can with the medical reports, medical records and opinions.
DELPHI AND GENERAL MOTORS EMPLOYEES: PPO: Office visits are paid at 70% of the allowed amount, the patient will be responsible for the 30% co-pay. Hearing tests are not covered unless they are in conjunction with the testing and fitting of a hearing aid once every 36 months.
TRADITIONAL: Hearing tests are covered only in conjunction with the testing and the fitting of a hearing aid once every 36 months. Office visits are not covered. Wax removal and microscopic exams are not covered by either plan. The guidelines are for Blue Shield. If you should have any questions, please contact the insurance office at the respective plants.