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Health Insurance Directory

St. Vincent Charity Medical Center accepts a variety of insurance products for coverage of services here at the Medical Center.

Below are the Plans with whom we have active contracts, including some for specialized services. These are for hospital services only, not for individual physician practices. For information on what insurance plans our physicians accept, please use our Find a Physician tool.


Find a Physician

BILLING, INSURANCE, MEDICAL RECORDS & PRIVACY

Our Financial Services Center submits all billing to insurance. You may get separate bills, one from the medical center, one from your doctor and others.

Please call the phone numbers listed on the bills if you:

  • Have questions
  • Need to correct insurance information
  • Want to know about Financial Assistance for balances due after insurance pays

Call the phone number on the specific bill you want to talk about.

HEALTH INSURANCE MARKETPLACE

You can also shop for insurance on the federal Health Insurance Marketplace. As Certified Application Counselors we can also facilitate your enrollment. Call our financial counselors for help.

Call: 216-694-4652 or 216-694-4653

NO HEALTH INSURANCE

You might not have health insurance. Someone from the hospital will visit you during your stay. This person will conduct a financial screening. This will let us know if you qualify for programs like Medicare or Medicaid. These state and federal programs can help you in the coverage of your medical expenses. All patients without health insurance will automatically qualify for discounted services. After review of your income, you may also qualify for free care or additional discounts through our financial assistance programs.

FINANCIAL ASSISTANCE PROGRAM

If you have no health insurance and/or do not qualify for state or federal programs, you will qualify for discounted care and may qualify for additional discounts or free care through St. Vincent Charity Medical Center's Financial Assistance Program (FAP). If you are uninsured and have balances after insurance that you are unable to pay, you may qualify for free or discounted care, through the FAP, if your income is below 400% of the poverty limit. The FAP is based on your income and Federal Poverty Guidelines. Guidelines are listed on the bill you receive. Call the number on the bill for information or you can call 800-721-6097. Our financial counselors are here to help, as well. You can reach a financial counselor at 216-694-4652 or 216-694-4653 from 8 a.m. - 4:30 p.m. Monday through Friday. A link to the financial aid application can be found here.

Comprehensive Hospital Charges

Learn more about the comprehensive hospital charges incurred for medical procedures at St. Vincent Charity Medical Center.

The information provided in the link below is a comprehensive list of charges for each inpatient and outpatient service, or item provided by a hospital, also known as a chargemaster. It is not a tool meant for patients to comparison shop between hospitals or to estimate what health care services are going to cost them out of their own pocket. For more information about the cost of your care, please contact our patient financial counselors at 216.694.4652 or 216.694.4653.

Comprehensive Hospital Charge List

Please note: This is a list of charges for all services we offer at St. Vincent Charity Medical Center. The amount listed is the amount billed by St. Vincent Charity Medical Center to your insurance company. Those insurers then apply their contracted rates to the services that are billed. This is not the amount you pay and we do not recommend using it as an estimate of what health care services will cost you out-of-pocket. The chargemasters are not helpful for a patient to comparison shop between hospitals or to estimate what health care services are going to cost you out of pocket. For more information about the hospital chargemaster list, please read the frequently asked questions below, or contact our patient financial counselors at 216.694.4652 or 216.694.4653.

 

A list of hospital charges can be found here

Diagnostic Related Grouping (DRG) List

This list offers the average inpatient charges per DRG grouping. A DRG is a collection of services you are provided as an inpatient and are used to create the hospital claim. This claim is then billed to Medicare, Medicaid or other health insurance companies. Those insurers then apply their contracted rates to the services that are billed.

 

A list DRG charges can be found here

Chargemaster Frequently Asked Questions

A chargemaster is a comprehensive list of charges for each inpatient and outpatient service or item provided by a hospital – each test, exam, surgical procedure, room charge, etc. Given the many services provided by hospitals 24 hours a day, seven days a week, a chargemaster contains thousands of services and related charges.

Chargemaster amounts are almost never billed to a patient or received as payment by a hospital. The chargemaster amounts are billed to an insurance company, Medicare, or Medicaid, and those insurers then apply a contracted rate to the services that are billed. In situations where a patient does not have insurance, St. Vincent Charity Medical Center has financial assistance policies that apply discounts to the amounts charged. For ,ore information on our financial assistance policies, a financial counselor can be reached at 216.694.4652 or 216.694.4653 from 8 a.m. - 4:30 p.m. Monday through Friday. More information, and a link to our financial aid application, can be found here.

Health insurance companies contract with hospitals to care for their customers. Hospitals are paid the insurance company’s contract rate, which generally is significantly less than the amount listed on the chargemaster. The insurance company’s contract rate, not the chargemaster, is the basis for determining the patient’s actual out of pocket costs. As an example, a hospital may charge $1,000 for a particular service, while the insurer’s contract rate may be $700. If the patient’s insurance plan indicates the patient is responsible for 20 percent of the contract rate, the patient would owe $140 ($700 x 20 percent).

Are charges the same for every patient?

The list of charges is the same for all patients. However, the total charges for an individual patient often vary from one patient to another for a number of reasons, including:

  • How long it takes to perform the service or how long it takes you to recover in the hospital
  • Whether the service or procedure you receive is more or less difficult than expected
  • What kinds of medication you require
  • Whether you experience complications and need additional treatment
  • Other health conditions you may have that may affect your care

Is the charge listed the cost the patient pays?

Chargemaster information is not particularly helpful for patients to estimate what health care services are going to cost them out of their own pocket. The charge listed in the chargemaster is generally not the amount a patient will pay. If you have health insurance, the amount you will be billed and expected to pay for your services depends on your specific health insurance coverage and your insurance company’s contract with the hospital. 

If you do not have health insurance, you may be eligible for reduced costs under the hospital’s financial assistance policy, or you may be eligible for Medicaid coverage.

What is not included on the chargemaster list?

The hospital’s chargemaster does not include charges for services provided by the doctor (or doctors) who treat you while you are at the hospital. You may receive separate bills from the hospital and the doctors involved in your care.

Here is a partial list of health care providers who may bill you separately:

  • Your personal doctor, if he/she sees you in the hospital
  • The surgeon who performs your procedure
  • The anesthesiologist who works with the surgeon
  • The radiologist who reads your x-rays or other imaging
  • Other doctors who may be consulted by your doctor during your time in the hospital
  • Laboratory testing

Where can I find more information about hospital costs?

If you would like more information about the chargemaster, what your care will cost you, or the hospitals’ financial assistance policy, please contact St. Vincent Charity Medical Center’s Financial Counselors at 216.694.4652, or 216.694.4653.

Please consult with your insurance provider to understand your insurance coverage, which charges will be covered, how much you will be billed, information on deductibles and your expected out-of-pocket responsibility.

MANAGED CARE PLANS WITH ACTIVE CONTRACTS - JANUARY 2018

Preferred Provider Organizations/PPO

Aetna Open Choice, Golden Choice
Aetna Managed Choice, Elect Choice
Anthem Blue Traditional
Anthem Blue Access Network; Federal Employees
Anthem Pathway and Pathway X PPO
Anthem Medicare PPO
Beech Street, a Viant Network
Cigna Health Plan
Confinity formerly PPOM /ASC Flora
DirectCare America - Interplan Health Group
Emerald Health Network - Interplan Health Group
First Health Network aka Coventry
Great West Healthcare (part of Cigna)
Health Ohio Network
HealthSmart
Multiplan
Ohio Health Choice
Ohio Preferred Network
ppoNext a Viant Network formerly HealthStar
Primary Health Services - Interplan Health Group
Prime Health Services (effective 3-14-11)
Primenet, Inc
Private Healthcare Systems, division of MultiPlan
SummaCare
SuperMed Plus (MMO)
SuperMed Classic (MMO)
SuperMed Select (MMO)
Tricare
United Healthcare of Ohio
Vet Choice
Web Health Solutions

Other Types

MES Solutions - Veteran Evaluation Services


Hospice

Community New Life Hospice, inpatient
Crossroads Hospice of NE Ohio
Harbor Light Hospice, inpatient
Heartland Hospice, inpatient & outpatient
Holy Family Hospice, inpatient
Hospice of the Good Shepherd, inpatient
Hospice of the Western Reserve, inpatient
Vitas HealthCare Corp, inpatient
VNA of Cleveland Hospice, inpatient & outpatient


Exchange Plans

Aetna
Anthem
Anthem Pathway X PPO
Anthem Pathway X HMO
Assurant
Buckeye
Healthspan (Shows in directory)
Medical Mutual
Molina Exchange


Health Maintenance Organizations/HMO

Aetna Select, Aetna Open Access HMO
Aetna Choice POS, Aetna POS II
Aetna Health Network Option
Aetna Network Only
Aetna Select Choice
Aetna US Access, Open Access Aetna Select
Anthem Blue Preferred Network
Anthem Pathway HMO
Cigna Health Plan
Great West Healthcare (part of Cigna)
SummaCare
SuperMed HMO; HMO Health Ohio (MMO)
United Healthcare of Ohio


Bariatric Surgery only DRG 288

Aultcare


Medicare HMOs

Aetna Golden Medicare
Anthem Senior Advantage
CareSource Advantage
Buckeye Community Health Plan
Evercare, a division of United Healthcare
Med Care Advantage Corp.
Medical Mutual of Ohio Medicare Advantage
Meridian Health Plan
Molina
SummaCare
United Healthcare, Select & Advantage
WellCare of Ohio, Inc. & PPO product
Gateway
Humana OPERS only (through 2015)


Medicaid HMOs

Buckeye Community Health Plan
CareSource Medicaid HMO
Unison
Paramount Health Plan


Behavioral Health Plans

Cenpatico Behavioral Health
Cigna Behavioral Health
CMIC/Ford Motor Co. (Anthem) - Magellan
Kaiser Permanente
Magellan Behavioral Health
United Behavioral Health/Optum
Value Options
Medical Mutual Metro HMO (Behavioral only) Cle Care


Dual Eligibles "My Care Ohio"

Buckeye
CareSource
United Healthcare

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