Dear patients and families,
Health insurance plans have shifted many costs to patients. Many patients, even those with premium insurance, are surprised when they receive a bill for services that they thought would be covered. It is your responsibility to understand your plan's benefits BEFORE your appointment.
Most medical insurance companies consider ophthalmology to be a specialty provider. This means:
- your insurance may require you to pay out-of-pocket for office visits ($240) and procedures until your deductible(s) has been met;
- even if your deductible(s) has been met, your insurance carrier may deny your claim for another reason;
- you may have a higher co-pay;
- you are responsible for all refractions ($40), co-insurance, deductibles, and non- covered services;
- there is no way for us to know ahead of time what your insurance will cover. Certain medical conditions may not be covered (even though they are true medical problemsWe encourage patients to call their insurance companies to learn their benefits before seeking care.
- Following your visit, you will receive an invoice for non-covered or denied services. This can take up to 6 months. Please remember that we are on your side. We contest and re-submit ALL insurance denials. If we absolutely cannot get your insurance to pay for your visit, then you will receive an invoice.
We DO NOT accept vision plans. We accept many PPO medical insurances.
We DO NOT provide free eye exams. If your insurance plan offers free annual eye exams and you wish to use this benefit, you must call your insurance to find out where to get a free exam. Our exams are not free.
When filling out your forms, please note: In order for your medical insurance to consider the claim, there must be a medical reason for the eye exam, such as:
- eye pain, irritation, itching, allergies, redness, stye, injury, tearing, etc.
- eyes crossing or wandering
- eyelid issues (excessive blinking, droopy eyelid, eyelid lesions, stye)
- headaches
- follow-up of a known eye problem
- having a medical problem (such as diabetes) which can affect the eyes
Your insurance will DENY claims for:
- “check up”, “routine” or “glasses” eye exams without any medical reason
- exams which turn out to be normal (no problems found on the exam) even if your child was referred by another doctor for a possible medical problem. If the exam turns out normal, you will be responsible for exam charges ($240).