What Cleveland Clinic offers and who it serves

Cleveland Clinic is a large hospital system based in Ohio that runs hospitals, clinics, and urgent care centers across Ohio, Florida, and other states. It operates its own health insurance plans in some regions and also accepts most major commercial insurance, Medicare, and Medicaid. If you receive care at a Cleveland Clinic location, you will either use your own insurance plan or pay out of pocket — Cleveland Clinic does not determine your coverage, but it does process claims and set its own prices for uninsured patients.

The system runs Cleveland Clinic Health Plan, which is available to some Ohio residents and employees of certain companies. This is separate from your Medicare or Medicaid coverage; it is a commercial plan that competes with other insurers in the same market. If you already have insurance through your job or through the federal marketplace, you likely will not need Cleveland Clinic's plan unless you are switching jobs or losing coverage.

Cleveland Clinic also has financial information programs for patients who cannot pay their bills. These are not the same as insurance — they reduce what you owe after care is delivered, based on your household income and expenses. Understanding which program you might use depends on whether you have insurance, what your income is, and what type of care you received.

Key Takeaways

  • Cleveland Clinic Health Plan is a commercial insurance option available to some Ohio residents and company employees, not a program for all patients.
  • If you already have insurance through your employer or the marketplace, you can use it at Cleveland Clinic locations that accept your plan.
  • Cleveland Clinic offers financial information to uninsured and underinsured patients based on income, which can reduce or eliminate what you owe.
  • You must request financial information; Cleveland Clinic does not automatically determine your may be able to access based on your income alone.
  • Payment plans are available for bills you cannot pay in full, and Cleveland Clinic has a patient advocate office to help resolve billing disputes.

Cleveland Clinic Health Plan coverage and enrollment

Cleveland Clinic Health Plan is a health maintenance organization (HMO) and preferred provider organization (PPO) plan sold to individuals and groups in Ohio. It is not open to everyone — you must live in a service area where the plan is offered, and availability changes by year. You can enroll during the federal open enrollment period (usually November through December) if you buy your own insurance, or during your employer's open enrollment if the plan is offered through your job.

The plan covers preventive care, hospital stays, doctor visits, and prescription drugs, with costs split between a monthly premium you pay and out-of-pocket costs (copays, coinsurance, and deductibles) when you use care. Like all commercial plans, it has a network of doctors and hospitals — Cleveland Clinic locations are in-network, but other providers may not be. If you use an out-of-network provider, you will pay more.

To learn about Cleveland Clinic Health Plan is sold in your area, you can contact Cleveland Clinic directly or check the plan's website during open enrollment. You cannot enroll outside of open enrollment unless you have a may have access to life event, such as losing other coverage, getting married, or having a baby.

Using your existing insurance at Cleveland Clinic

If you have insurance through your job, Medicare, Medicaid, or the federal marketplace, you can use it at most Cleveland Clinic locations. Before your appointment, call the clinic or check your insurance card to confirm that the specific location accepts your plan. Some Cleveland Clinic facilities may be in-network for some plans and out-of-network for others.

When you arrive for care, bring your insurance card and a photo ID. Cleveland Clinic will verify your coverage and bill your insurance company directly. You will owe any copay, coinsurance, or deductible that your plan requires. If your insurance is denied or if there is a billing error, Cleveland Clinic has a patient advocate office that can help you resolve it — you can request an advocate by calling the billing department or asking at the front desk.

If you are uninsured or your insurance does not cover the full cost, you may be able to use Cleveland Clinic's financial information programs (described below). Do not ignore a bill hoping it will go away — contact Cleveland Clinic's billing department as soon as you know you cannot pay, because information programs have important date and income limits.

Financial information for uninsured and underinsured patients

Cleveland Clinic offers charity care and financial information to patients whose household income is below a certain threshold. The income limit varies by state and changes yearly; in Ohio, it is typically 200% to 400% of the federal poverty level, depending on the program. You must request this information — Cleveland Clinic does not automatically determine your may be able to access.

To request financial information, contact Cleveland Clinic's billing department or financial counselor after you receive your bill. You will need to provide proof of household income (such as recent tax returns, pay stubs, or a letter stating you receive no income) and proof of household size (such as a lease or utility bill). Cleveland Clinic will review your information and tell you whether you may have access to and how much of your bill will be reduced or forgiven.

If your income is above the charity care threshold but you still cannot afford your bill, Cleveland Clinic offers payment plans with no interest. You can pay your bill in monthly installments over a set period. Ask the financial counselor about payment plan options when you request information.

Uninsured patient pricing and payment options

If you do not have insurance and do not may have access to for financial information, Cleveland Clinic will charge you its standard rates for care. These rates are set by Cleveland Clinic and vary by service — an office visit costs less than a surgery, for example. You can ask for an estimate of costs before your appointment, though the final bill may differ if your care changes during the visit.

You can pay your bill in full when you receive it, or you can ask about a payment plan. Cleveland Clinic accepts credit cards, bank transfers, and checks. If you fall behind on payments, Cleveland Clinic may send your account to a collection agency, which will damage your credit score. To avoid this, contact the billing department as soon as you know you cannot pay — even if you do not may have access to for information, a payment plan is better than nonpayment.

Some uninsured patients also use medical credit cards (such as CareCredit) to pay their bills. These cards charge interest if you do not pay off the balance within a promotional period, so read the terms carefully before explore.

Billing disputes and patient advocacy

If you believe your bill is wrong — because of a duplicate charge, an error in coding, or a service you did not receive — you can dispute it. Contact Cleveland Clinic's billing department and explain the error. Keep copies of all bills, insurance statements, and correspondence. If the billing department does not resolve the dispute to your satisfaction, you can request a patient advocate.

Cleveland Clinic's patient advocate office is separate from billing and can investigate complaints about billing, care, or service. You can request an advocate by phone or in writing. The advocate will review your case and work with the appropriate department to resolve it. This process is free and does not require a lawyer.

If you have a complaint about Cleveland Clinic Health Plan specifically (not about a hospital bill), you can file a complaint with the Ohio Department of Insurance. The department investigates complaints about insurance practices and can order the plan to take action if it finds a violation.

Medicare and Medicaid coverage at Cleveland Clinic

Cleveland Clinic accepts Medicare (federal insurance for people 65 and older and some younger people with disabilities) and Medicaid (state insurance for low-income people) at most of its locations. If you have Medicare or Medicaid, bring your card to your appointment and Cleveland Clinic will bill the program directly. You will owe any copay or coinsurance that your coverage requires.

Some Cleveland Clinic doctors participate in Medicare Advantage plans (private insurance plans that cover Medicare benefits). If you have a Medicare Advantage plan, check whether your doctor is in-network before your appointment. If your doctor is out-of-network, you may pay more or the plan may not cover the visit at all.

If you have both Medicare and Medicaid (called "dual may be able to access"), Cleveland Clinic will bill both programs. Medicare pays first, then Medicaid covers what Medicare does not pay, up to the Medicaid rate. You should owe little or nothing out of pocket, but bring both cards to confirm.

Frequently Asked Questions

Can I use Cleveland Clinic if I have Medicaid from a different state?

It depends on which Cleveland Clinic location you visit and which state's Medicaid you have. Cleveland Clinic has locations in Ohio and Florida, and Medicaid is run by each state separately. Call the clinic before your appointment to confirm that they accept your state's Medicaid. If they do not, you may have to pay out of pocket or find a provider that accepts your coverage.

What happens if I cannot pay my bill and do not may have access to for financial information?

You can ask about a payment plan with no interest, which lets you pay your bill in monthly installments. If you do not set up a plan and do not pay, Cleveland Clinic may send your account to a collection agency. Contact the billing department before this happens to discuss your options.

How do I know if a Cleveland Clinic doctor is in-network for my insurance?

Call your insurance company or check your plan's website for the provider directory. Search for the doctor's name and the Cleveland Clinic location. If the doctor does not appear, call Cleveland Clinic's main number and ask whether that doctor accepts your plan. In-network status can change, so confirm before your appointment.

Do I have to use Cleveland Clinic Health Plan if I work for Cleveland Clinic?

No. If your employer offers Cleveland Clinic Health Plan, you can choose it during open enrollment, but you can also choose another plan if one is offered. Review all available plans and pick the one that best fits your needs and budget. You can change plans during the next open enrollment period if you change your mind.

What is the difference between charity care and a payment plan?

Charity care reduces or forgives your bill based on your income — if you may have access to, you owe less money. A payment plan lets you pay what you owe in monthly installments instead of all at once. You may may have access to for charity care, a payment plan, or both, depending on your income and the size of your bill.