It is your responsibility to know what your vision insurance benefits are, but as a courtesy we try to help our patients the best we can.
Vision insurance contributes a certain dollar amount towards the routine eye exam fees or contact lens fitting fees and certain vision insurance plans allow a discount for hardware (glasses or contact lenses). Every vision insurance has different stipulations, so to be able to maximize your benefit it is important for you to understand your particular plan. If you need details about your vision insurance you can contact the number on the back of your insurance card or contact your human resources center.
Medical insurance is used for eye related medical conditions. At times, during your routine eye exam, there may be medical conditions that require further investigation or tests to help us thoroughly care for your eyes. Having your medical card information in your file is valuable to us. This is different from billing your vision insurance for a routine eye exam and is subject to any deductibles, copays, or co-insurances. Again, every medical insurance has different stipulations, so to be able to maximize your benefit it is important for you to understand the details of your medical insurance. If you need details about your medical insurance you can call the number on the back of your insurance card or contact your human resources representative.
Having a medical insurance card or vision insurance does not guarantee payment for the services provided. Until we bill the services provided to you to your insurance company whether it is vision or medical we will not know your full balance until we receive an explanation of benefit (EOB) or explanation of payment (EOP). If there is an amount that your insurance does not contribute or if deductibles have not been met, then we will send you an invoice in the mail. Because of how slowly or quickly the insurance companies process your claim, an invoice could come weeks to months after the date of when you received your services.
"In network" means that our clinic is contracted with your insurance company, whether it be vision or medical. It is best to check with your insurance company to see if we are an in network provider. If we are an in network provider for your insurance, then your fees will likely be at a discounted rate because of the contract we hold with them. It is possible to receive an invoice for the remainder balance after the discount has been applied.
"Out Of Network"
"Out of network" means that our clinic is not contracted with your insurance company whether it be vision or medical. If we are an out of network provider for your insurance company, then you are responsible for payment for your services in full. To help make things easy for you, we submit the claim forms to your insurer and after the claim is processed, the insurance company will mail you the reimbursement check within 3 weeks. Reimbursements vary greatly and range from $20 to $105. To gain a full understanding of how this may work for your individual insurance plan call the number on the back of your insurance card for details.
Here are some of the insurances that we are contracted with:
First Choice (Carpenters Trust, Group Health Options (PPO plans only), Healthcomp, KPS, Providence Health Plan, Sound Health, UMR)
Health Management Administration (HMA)
Do you not see your insurance listed? Give us a call to check if your insurance is one that we are contracted with.