Advanced Eyecare and Laser Center P.C.  
     
     
Insurance

Office Policies--Billing and Insurances


ADVANCED EYECARE AND LASER CENTER

INSURANCES AND BILLING

As a service to patients we accept reductions in our usual fees by participating in most area health plans. These include:

Medicare and Medicare Advantage
Medicaid and Medicaid HMOs
Aetna-US Healthcare
Amerihealth/Choice/Group
All Blues Plans
Horizon/ Horizon Mercy
Cigna
Medigroup
United Health
Prucare
Intergroup
Davis Vision
Keystone
Tricare
Qualcare

...and many, many others!

Please consult your plan booklet for what is and isn't covered.

For Eye Services, many plans distinguish between "vision care" and medical/surgical eyecare.

VISION CARE is often a rider to a more comprehensive medical plan. It covers routine, non-emergency visits, when there is no medical or surgical problem; and no complaints or symptoms. There may be discounts on glasses or contacts.

Even if you have no vision care plan, the MED/SURG plan will cover eye visits where there is a diagnostic problem or chronic condition that needs monitoring or treatment.

If your company or group does not have a vision care rider, let us know, and perhaps we can customize a plan for your purposes.

Medicare does NOT cover routine visits under any circumstance! It also does not cover the measurement for glasses, called "refraction." Medicare does not cover eyeglasses or contacts, with one exception: Post cataract surgery eyewear is covered ONCE per lifetime.

Medicare also never provides full coverage. They pay 80% of what they allow a participating doctor to charge. They also charge a yearly deductible. These amounts are by law the patient's responsibility, unless another (secondary) plan pays them. The doctor may not write them off unless significant hardship exists. It is your responsibility to provide us with the correct and up-to-date information on any secondary insurances you have, and to make sure your coverage is current on the date of service.

In order for us to file your Medicare claim and receive payment you must sign a form that assigns the benefit to us.

Medicaid covers routine visits and some eyewear.

Those with no insurance and severe eye disease can sometimes obtain coverage through the New Jersey Commission for the Blind and Visually Handicapped.

When we have a contract with your plan, we bill your insurance for this fee. In some cases there is a deductible or co-payment, which is DUE AT THE TIME OF SERVICE. Some plans also require referrals from the primary care doctor in order for a service to be covered. We make every effort to inform you and the primary care doctor what the expected services to be provided will be, ahead of time, so as not to delay your care. It is YOUR responsibility to pick up the referral!

Your HMO may not cover all necessary or desired services. You are responsible for services not covered. You should understand what your insurance does and doesn't cover.

Some patients have plans that do not require referrals. Some plans have different coverages depending if the doctor is in network. If we are not in network, let us know and we will try to become part of the network, unless it is not economically feasible for us to do so. For plans that we are not contracted with, you may have out of network coverage. For all non-covered services of any plan, payment is due at the time of service unless other arrangements have been made.

Some out of network plans reimburse the patient for services rendered. The patient is supposed to pay for the service. For your convenience we will allow you to receive the payment first, and then pay us. Remember that in these cases you still have the payment responsibility!

If there is no coverage for a service or procedure, payment arrangements will be discussed and worked out in advance. This could also include cosmetic and elective procedures, or upgraded cataract implants. In some elective procedures, financing can be obtained through third parties. We also accept MATERCARD, VISA, and DISCOVER cards.

In some cases we do not know in advance as to whether Medicare or other insurance will or won't cover a service. If we are unsure you may be asked to sign a form indicating that we have so informed you and that the bill is your responsibility if Medicare denies the coverage.

For contact lenses, full payment is required to order. A fitting is required to establish a contact lens prescription.

Despite best efforts, questions and problems occasionally do arise about insurance issues. We attempt to verify coverage at the time of your visit prior to your being seen. You can help by making sure you do not schedule an "insurance-covered" elective appointment AFTER your coverage has expired!

Please do not hesitate to bring any questions or problems to our attention. The health of your eyes is our primary concern!

PLEASE BRING ALL YOUR UP-TO-DATE INSURANCE CARDS WITH YOU AT EACH VISIT!