We are participating providers for the following insurances only:
Blue Cross Blue Shield
Blue Care Network
Blue Choice
Priority Health HMO
Priority Health Medicaid
*Medicaid
*Medicare
*We do not participate with Medicare/ Medicaid plans outside of traditional Medicare / Medicaid
**Children's Special Health- we must be listed as a provider prior to your visit
**If we are not listed with CSHS at the time of your visit, you will be expected to provide payment at the time of service.
We do not participate with any insurer not listed. We do not participate with other Medicaid or Medicare plans. Therefore, payment is due at the conclusion of your visit and we will not bill your insurance carrier.
It is important to understand that there may be services which are necessary for diagnosis and treatment that your insurance does not cover. In this event, you will be notified at check in and this fee will be collected at the end of your appointment along with co-pays, deductibles and any past due balances. Collecting all amounts due at the end of the visit is necessary to keep medical costs down. Please be advised that participation does not mean that 100% of your visit will be covered. Please make note that Priority Health has determined refractions are the patient's responsibility. Medicare has never covered refractions and therefore we do not bill to Medicare. We encourage you to review your coverage with your insurer prior to your appointment. Questions regarding payment plans can be addressed to our billing department prior to your appointment. Payment plans will be created by using the MPAY method. A credit card will be required and a designated amount will be withdrawn on the 15th of each month until your payment plan is satisfied. Please be prepared to pay cash, check, or Visa and Master Card. Our preferred method of payment is by using credit card and we will request an authorization on your balance of the visit.
Refractions
Policy Statement from AAPOS regarding refractions
Childhood eye disease and/or abnormalities require thorough medical and ophthalmologic evaluation. Many times additional diagnostic testing is required such as refraction. Refraction is the determination of the refractive state including prescription of any necessary corrective lens(es).
Refractions are needed to properly diagnose and effectively treat the differences in refractive error between the eyes which may be the cause of lazy eye (amblyopia) or misalignment of the eyes (strabismus). Left untreated, these conditions may lead to permanent, irreversible visual loss that is not treatable with glasses, surgery, medicines or lasers.
Refractions are a medical necessity in children and are not included as a component of an ophthalmology or an E/M exam code.
The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) adopts the following policy: (1) Refractions in children are a medical necessity and (2) the cost for refractions in children should be considered as a separate and reimbursable service to be paid for either by the third party payor or the patient.
Approved October 23, 1999
CPT-copyright by the American Medical Association
The above information is true for the adult population with ocular motility diagnoses.
Refractions for medicare patients are not billed to Medicare as Medicare doesn't cover them. Refractions are not optional. A refraction is done for the determination of values to provide treatment.
Authorizations may be part of your insurance plan requirement. This is your responsibility to determine if this applies and to secure an authorization or referral before your visit. You may want to discuss this with the physician that is referring you to our practice. Unfortunately, we can not see a scheduled patient if there is no authorization or referral for the visit. You may choose to continue with the visit and pay for the visit with the understanding that you/we can not obtain authorization after your visit and we will not bill your insurance or reimburse you.
Cancellations / No Show Visits
We are mindful of the costs of health care as a provider. Therefore, we ask that if you are unable to keep your appointment, we are given no less than a 24 hour notice of cancellation. Patients that do not show for their appointment will incur a $50 charge as well as those appointments broken less than 24 hours of the appointed time. There are patients that need your appointment time if you are unable to keep your appointment.
Auto Pay Program
MPAY is the credit card processor. Credit cards are the preferred method of payment. You will be asked to present your credit card upon check-out at which time we will swipe your card for payment and authorization. Authorizations are necessary so that when your insurance returns the explanation of benefits (EOB) indicating a balance owed, we can process this payment immediately without sending statements. This process will provide cost savings to you and our practice. We do not retain any credit card information. It is the same process used when swiping your credit card at the gas pump, when you make purchases at retailers or when making on-line payments. When using a debit card to make your payment and an authorization is used with the debit card, your bank may hold funds for up to 72 hours. The authorization process is between your credit card company and your bank. Again, at no time to when access to or do we hold onto your credit card information.