If we are a participating provider for your insurance plan, we will accept the assignment of benefits and file the claim for you. You will be asked to pay for your co-pay, deductible, or any non-covered services or materials. You must present your insurance ID card and/or subscriber information before your examination. If you have an HMO plan, it is your responsibility to get authorization before your appointment. If you do not have authorization and your claim is denied, you will be responsible for the cost of your visit.
We must emphasize as your health care provider, our relationship is with you and our primary concern is your health. Your insurance is a contract between you/your employer, and the insurance company. We are not party to that contract. We will do our best to assist you in obtaining information or referrals, but it is ultimately your responsibility to know what your policy covers and requires. This information is commonly found on your insurance company website.
Our doctor will prescribe lenses that meet your needs both optically and medically. Our optical team will review this prescription with you and help you to understand what your insurance might contribute toward your purchase. Along with helping you choose an appropriate frame, they will offer you options that may make you more comfortable in your glasses. Because lenses are custom made to your prescription, they are non-refundable. Payment is expected in full at the time of the order, and once payment is made, this order cannot be changed or canceled.
A contact lens fitting and evaluation is required before all contact lens sales which do not have a current prescription. A contact lens fitting requires additional testing and evaluation that is not part of a routine eye examination and must be repeated annually. A fee will be charged in addition to the eye exam fee. Your insurance company may cover part of this exam, or not at all. Trial lenses will not be dispensed without payment of this fee.
There are two types of health insurance that will help pay for your eye care services and products. You may have both and our practice accepts both:
1. Vision Insurance plans (such as VSP, EyeMed, Humana)
- Vision Insurance Plans are actually a vision benefit. They are designed to pay for routine vision exams, eyeglasses, and contact lenses. Vision plans cover a comprehensive screening for eye disease. They do not cover diagnosis, management, or treatment of eye diseases.
2. Medical insurance plans (such as Blue Cross/Blue Shield, UHC, Aetna, and Medicare)
If you have both types of insurance plans it may be necessary for us to bill some services to one plan and other services to the other. We will use coordination of benefits to do this properly and to minimize your out-of-pocket expense. It is in your best interest to be familiar with your Vision and Medical plans, including deductibles and co-pay information. Visit the website of your insurance company and verify what is included in your plan. Knowing your insurance information will allow us to provide you with the most efficient and accurate service possible.
- Medical insurance must be used if you have any eye health problem or systemic health problem that has ocular complications (such as diabetes, glaucoma, or macular degeneration). Your doctor will determine if these conditions apply to you, but some are determined by your case history.
- You will be asked to pay any estimated co-pays or deductibles at the time of your visit.
- We will bill your insurance plan for services if we are a participating provider for that plan. If required, we will try to obtain advanced authorization of your insurance benefits. If some fees are not paid by your plan, we will bill you for any unpaid deductibles, co-pays, or non-covered services as allowed by the insurance contract.