Explanation of Your Health Insurance and Billing
In an effort to ensure that any questions you may have about the billing of your insurance company are answered, we have prepared this overview of the insurance billing process.
Although it is the patient’s responsibility to know and understand their insurance coverage we are here to help in any way we can. Our office does not make the rules/policies between you and your insurance company and it is up to each patient to discuss any
misunderstandings or appeals directly with your insurance company.
Definitions of Health Insurance Terms
The amount that must be paid by each patient each year for health care expenses before the insurance company begins to pay. This includes patients covered by Medicare.
Many insurance plans require patients to pay a portion of their health care
costs after first meeting the deductible. This coinsurance is usually a percentage of the total fee up to the patient’s out-of-pocket limit. This includes patients covered by Medicare.
Most insurance plans will pay all of the costs after the deductible and coinsurance limit is met.
Some patients are covered by more than one insurance plan. Secondary insurance carriers are billed only after the primary insurance carrier has paid their portion of the covered expenses. Secondary insurance may cover the deductible and coinsurance amounts not paid by the primary insurance.
Many insurance carriers require that some procedures be preauthorized. A preauthorization will determine if the proposed procedure is a covered expense under your insurance plan. Our office will call your insurance carrier to make this determination. Preauthorization from your insurance carrier does not guarantee their payment, but usually means they will do so.
Vision Insurance vs. Medical Insurance
Eye doctors are the only health care providers that must follow two different sets of insurance regulations. When you have both types of insurance, the reason for your visit dictates which insurance covers your visit. Vision insurance covers only visits for a patient that has NO signs, symptoms, complaints or previous diagnosis of conditions and just wants new glasses or
contact lenses. If however, there is a sign, symptom or complaint (such as red eyes, blurred vision, tired eyes, headaches, eye irritation, etc.) or diagnosis of a previous problem (e.g.
diabetes, glaucoma suspect, cataract, prolonged use of medicine, dry eyes, etc) then your medical insurance covers your visit.
After your exam we will bill your insurance carrier. Your insurance carrier will review the bill and, in most cases pay their portion within 90 days. If you have secondary insurance, that carrier will be billed after we obtain payment from the primary carrier.
We will collect any deductible and/or coinsurance amounts due to Master Eye Associates at the time of your visit.
We are required by law to collect all co-payments, coinsurance and deductibles. Although we will make every effort to collect from your insurance carrier, you are ultimately responsible
for the payment of your fees in full. If we are unable to verify your insurance coverage, you will have several options to pay the insurance portion of your fee at the time of service.
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Privilege of Allowing Us to Care for You