Knowing what your insurance covers and does not cover is an important aspect in making your experience a positive one. Please do not ask our staff or doctors to bill your insurance in certain ways to avoid co-pays or deductibles. We are mandated to follow the strictest guideline set forth by your managed care plan when billing is involved. Please don’t hesitate to ask us any insurance questions you may have prior to your visit.
We kindly ask you to bring your insurance card(s) to your visit. In order to properly bill your insurance(s), we require that you provide accurate and current insurance information, including primary and secondary coverages to avoid inaccurate billing. Final coverage amounts and reimbursements will ultimately be determined by your insurance company. Any charges not covered by your insurance will be billed to you separately. Although we are pretty adept at estimating the final bill, ultimately your insurance company will make the final determination of eligibilities and benefits. We would still be happy to provide you with our excellent services even if your insurance company is not contracted with us.
No vision plan, no problem
Many times your medical insurance alone will cover most of the eye exam if you have any specific problems with your eyes. That includes dry eyes, itchy eyes, eye pain, red eyes, cataracts, glaucoma suspicion, diabetes, sudden onset blurred vision…you get the idea. Call us and let us know your complaints, and we’ll let you know if your medical insurance will cover your eye exam.
Routine (Vision Plans) vs. Medical Exam
Most supplemental Vision Plan include a “routine” or basic eye exam as part of its coverage. These exams are more of a screening exam, suited for those individuals with no ocular conditions, symptoms or findings. If however, there is a medical condition discovered during your routine eye exam you will be informed and the type of insurance coverage will likely change at the next visit depending on which plan you are using to cover the examination. Since vision plans do not cover medical diagnoses, your medical insurance will be used instead, even if you have a high deductible plan. Any treatment or long term monitoring of eye conditions will be covered by your medical insurance and not by the vision plan. When it comes to your eye wear, some vision plans will even dictate where your glasses will be made, and often times not somewhere of our choosing. When this happens, it becomes difficult for us to ensure the highest standards that we strive for and that you deserve. If you have any questions, please don’t hesitate to call us.
High Deductible Medical Plans
These medical plans are gaining popularity due to the initial lower cost of purchase but may leave the patient underinsured. These plans result in a much higher out of pocket cost to the patient until those deductibles are met. To offset the high deductibles, patients will generally have a Flex Savings Account to help with the cost. This challenge is a serious one because increasing deductibles can interrupt the continuity of care and cause financial anxiety when additional, but necessary ancillary testing is needed to detect and manage ocular diseases that can cause permanent vision loss. With such severe consequences, we will work with you to find a solution and still give the care that you need. Also remember, if we are part of your network, your insurance will have a contracted rate with us to help lower the cost. These rates are established by your insurance provider and will be documented by your “explanation of benefits” report.
Please also look at this helpful High Deductible Plan Explanation.
All co-payments are due at the time of your visit. We accept cash, check or credit cards. A fee will be added if the co-pay is overdue.
Self Pay – No Insurance
For some, the lack of insurance and the prices of health care makes going to the doctor difficult. We will do our best to accommodate your needs with discounts for self-pay patients and payment plans to make it affordable. Call us to inquire.
The charge for a returned check is $20.00 payable by cash or credit card. This will be applied to your account in addition to the insufficient funds amount. You may be placed on a cash only basis following any returned check.
The parent(s) or guardian(s) who accompanies the minor is responsible for full payment and will receive the billing statements.
If your account becomes delinquent and you have not established or met payment options with our billing office, your account may be turned over to a collection agency. Outstanding balances must be resolved prior to any non-emergency appointments.
This Financial Policy helps the office provide quality care to our valued patients. If you have any questions or need clarification of any of the above policies, please feel free to contact us at (860) 660-2400