Our staff will file visit changes to your primary insurance carrier, if we are providers for that plan. Patients are responsible for providing our staff with the plan name, member id number, in some cases the social security number and customer service phone number prior to their scheduled appointment date. We will obtain benefit information and member status, however this is no guarantee of payment by your insurance carrier.
Patients must advise our office of their insurance information PRIOR to their appointment as we will not file claims retroactively. Knowing your insurance is key.
Patients are also responsible for obtaining their own referrals from their Primary Care Physicians (PCP). Please contact your particular insurance carrier to inquire about a referral for your office visit. If a patient does not have their required referral we will reschedule the appointment until one can be obtained.
Insurance carriers have divided their coverage plans into two categories for Optometric services.
Routine Eye Exams - (with or without) coverage for Materials - glasses and contact lenses
Most insurance plans for medical coverage, will cover a patient's illness or injury visit. Not all insurance plans have coverage for Routine Exams.
Insurance companies define office visits for ILLNESS/INJURY to be the treatment of a problem. Examples include patients with a history of glaucoma, diabetes, high blood pressure, cataracts, macular degeneration, strabismus, dry eyes, excessive tearing, decreased vision due to a droopy eyelid, adverse effects of on-going medication, surgery to correct some problem, to name just a few. Also, patients seeking treatment for pain, sudden loss of vision head or eye trauma including foreign body (or chemicals) in the eye are covered in this category.
Some reasons for ROUTINE EYE EXAMS would be prescription change in your glasses or contact lenses, annual exams for contact lens wearers, headaches related to vision correction, blurry vision, LASIK exams, new problems with close up or distant vision, and school exams.
Coverage for Materials such as glasses and contact lenses is not a benefit under all plans. You should contact your insurance carrier to ask if this is a benefit under your particular plan. Some plans will have coverage under a different carrier name other and your primary medical carrier, or will have separate Vision plans.