Deductible
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.
Coinsurance
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.
Out-of-Pocket Limit
Most insurance plans will pay all of the costs after the deductible and coinsurance limit is met.
Secondary Insurance
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.
Preauthorization
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.