I have Medicare and a secondary carrier, Medicare has paid their portion, will the balance be sent to my secondary carrier?
Yes! If Medicare has not forwarded the balance to your secondary carrier - we will. Many secondary carriers are set up with Medicare to have the claims automatically crossed over to them. If your carrier is not - we will send the claim to your secondary carrier for you..

I forgot to give my vision plan information to you and the claim has been sent to my medical carrier and denied. Can you still submit to my vision plan?
Yes, provided you were eligible and we are still able to obtain an authorization number. Some vision plans limit the time we can submit a claim for you. We will need the ID# or social security number of the policy holder along with the policy holders date of birth. We will either go online or call your carrier and if we can obtain an authorization - we will submit your vision exam for you.

I have Medicare and have been told you accept assignment. Does this mean you accept their payment in full and I am not responsible?
We are a preferred provider for Medicare and accept assignment with Medicare. Medicare pays 80% if what they allow. The remaining 20% us due by the patient unless you have a secondary carrier that covers this amount. However, secondary carriers only pay 80% if the 20% Medicare did not pay. In this case there would be a balance due by the patient. All plans are different and you should check with your secondary carrier to be sure. If you do not have a secondary carrier, the 20% would be your responsibility.

I have an HMO medical plan, do I have to obtain a referral or authorization prior to my visit?
Many HMO plans have protocols which must be followed before you can be seen or before any procedures can be performed. HMO plans often revise their requirements for their members. Many plans no longer require referral for routine exams. Most plans DO require referral for special testing and/or surgeries regardless if done in our office or a hospital. If after your exam - you require additional special testing, these tests will be scheduled on another day and you will be asked to contact your primary care physician for the referral. If a surgical procedure is required, you will need to contact you primary care physicians for the referral and then our surgical coordinator will be able to call your insurance carrier for pre-certification and prior authorization. This referral MUST be in your insurance carriers system PRIOR to obtaining pre-certification & prior authorization. Always check with your primary care physician if you have any doubts.

Who do I contact if I have a question regarding my statement?
You may call our office Monday - Friday between 8:30 am and 4:30 pm. Most questions can be answered by the receptionist. If you have additional questions regarding your insurance carrier or insurance payment, please call Tuesday or Thursday between 10 am and 12 pm. Please ask for Boni, Pam or Donna.

My insurance has paid you for a service that I have already paid, how do I obtain the refund?
You may call our office during regular business hours (8:30 - 4:30) and ask for Donna. Donna will be able to tell you if a refund is due and when you may expect to receive it.

Will my insurance cover my exam and all my tests? Will my insurance pay for my glasses?
It is always best to check with your insurance carrier prior to your visit to verify if services will be covered. There are numerous insurance carriers and each carrier may choose from many different plans. Some plans cover routine eye exams while others will only cover medical exams with a medical diagnosis. Some plans have a vision "rider" attached or may utilize a different carrier for their vision care which is entirely separate from your medical plan.

Medicare will NOT pay for a routine eye exam. Medicare will pay for an ophthalmic exam for medical related problems or a screening exam for certain diseases. Most ophthalmic special testing will be covered if there is a medical diagnosis to warrant the test. If we feel there is a reason the service may not be covered, we will inform you prior to the testing and ask you to sign an Advanced Beneficiary Notice form that will indicate we feel the test may not be covered and why. You will be asked to sign a waiver of responsibility.

Glasses or contacts are only covered under your vision plan unless you have cataract surgery. You should contact your vision carrier prior to purchasing any optical materials to verify your eligibility and coverage. If we participate with you insurance carrier, we can go online to obtain your coverage and benefits and obtain an authorization for you.

Medicare covers a pair of glasses (standard frame & standard lenses) after each cataract surgery. Medicare will pay 80% of what they allow. The 20% balance is your responsibility unless you have secondary insurance. We will send to your secondary insurance carrier for their consideration if Medicare does not cross over to them. Medicare will not cover any premium addition to those glasses such as designer frames, progressive lenses, tinted lenses, anti-glare coating, and others. Ask out optician the covered items allowed by your insurance plans.

What vision insurance carriers do you participate with?
We continue to increase our participation with various vision and medical insurance carriers to better serve our patients. Some of our vision insurance carriers are:

EyeMed (Cole Vision)

DVSC, Inc (Clarity Vision)

Spectera

Superior Vision Plan

Vision One Discount Plan

When do I have to pay my co-pay?
Co-pays are due at the time of your eye exam or once services are rendered