Our Fees and Payment Policies
To Our Patients:
We are here to provide you with the eye care you need. We have established fees and payment policies that enable us to have the quality staff and facilities that are necessary to provide the care you expect. This explanation of our payment policies has been prepared so that you can help us maintain quality services. Like you, we are very concerned about the cost of health care. Our payment policies are designed to enable us to reduce unnecessary collection costs which would otherwise increase the cost to our patients.
We know that insurance plans are confusing to almost everyone. However, by understanding your insurance or HMO plan’s requirements and our policies you will avoid surprises regarding your payment obligations. Our staff is available at each office to explain our policies.
Your Responsibilities For Charges
You are ultimately responsible for the payment of charges for services you receive. We rely on the accuracy of information you provide to determine if a third party will be responsible for payment. If you will be paying personally for services or if you are responsible for a deductible or co-payment, we expect payment at the time service is rendered. We accept cash, personal checks, VISA, MasterCard, Discover and American Express. For surgical services and charges from our Ambulatory Surgery Center, we also accept Care Credit. If you are experiencing personal circumstances that will make the payment of our charges difficult for you, please ask to speak with our business supervisor prior to your visit.
If payment is to be made through an insurance or medical plan and we have agreed to accept assignment from that plan, then you are responsible for complying with all procedures required by that plan to enable us to receive payment on your behalf. To assure that your insurance or medical plans will provide covered benefits, you must let us know at the time you schedule your appointment and when you check in, how you plan to provide payment for your visit.
You are responsible for payment of any non-covered services as well as finance charges for overdue payments and fees for returned checks and collection agencies.
Medical Vs. Vision Services
Insurance plans differentiate between”medical” and”vision” problems. Most medical insurance plans do not pay for “vision” services. Most vision plans do not pay for “medical” problems. While some medical problems are obvious, when you have an eye problem, it may be almost impossible for you to know if it is a “vision” or “medical” problem. If you have a medical eye problem, we can file a claim with your medical plan. If you simply need an eye exam for glasses, that is usually a “vision” service and would not be covered by a “medical” plan but would be covered if you have a “vision” rider or a separate “vision” plan such as VSP or Eyemed.
When you make your appointment, please let us know what plans you have and we will help you determine which plans may be appropriate for your visit.
Medicare And Supplemental Plans
We accept assignment for Medicare and will file supplemental insurance claims for those plans that accept a claim directly from Medicare. If your supplemental plan does not accept a claim directly from Medicare, you must pay the co-payment to us and file a claim to your plan after you receive your EOB (Explanation of Benefits) from Medicare. A refraction, which is normally part of an eye examination, is NOT a covered service under Medicare and payment is your responsibility.
Your insurance company determines what they will or will not pay for. We rely on what an insurance company representative tells us to make an initial determination of coverage. Subsequent decisions made by your insurance company are outside of our control. We will generally file insurance for you for covered services. We do expect you to make prompt payment for any portion which the insurance company will not be responsible.
We participate with many of the HMO and POS plans and other managed care medical plans currently offered in this area. If a written referral is required by your plan, you must provide such referral before the service is provided. If you do not have a valid referral form at the time of your visit, it will be necessary for you to pay for services at the time of the visit or to reschedule the visit.
Refraction Service And Fee
A refraction is the process of determining if there is a need for corrective eyeglasses or contact lenses. It is an essential part of an eye examination and necessary to write a prescription for glasses or contact lenses. It is NOT a covered service by Medicare or most insurance plans. These plans consider a refraction a “vision” service not a “medical” service. Our office fee for a refraction is currently $75.00 and this fee is collected at the time of service in addition to any copayment your plan may require. However, if you pay at the time of service, we will allow you a prompt pay discount of $20.00. So your net cost would be $55.00. We will not file the charge for a refraction with an insurance plan unless we know that your plan pays for the refraction charge. Should your plan pay us for the refraction, we will reimburse you accordingly.
Contact Lens Evaluation and Fee
If you are having an eye examination and wear contact lenses, our professional staff will be evaluating your current contact lenses to determine the present appropriateness of your lenses. Our current fee for this service is $60.00 or more depending on the complexity of your prescription and is collected in addition to the fee for an eye examination.
Assignment And Medical Release Authorization
In order to request payment from any third party coverage, we will ask you to authorize payment directly to Thomas Eye Group for services rendered to you. We will also request your authorization for any holder of medical or other necessary information about you to release to the Social Security Administration and Health Care Financing Administration or its intermediaries or carriers, or to the billing agents of your insurance companies, or medical care plans, or to your employer for a Workers’ Compensation claim, any information needed to determine benefits or make payments for a medical benefits claim.
Finance Charges And Return Check Fees
We appreciate that most of our patients are conscientious about timely payment. We regret the necessity of having to apply fees to collect delayed payments; however, these fees are necessary so that we do not pass on these costs to those who pay on a timely basis.
Thomas Eye Group will charge a minimum of $15.00 on all accounts with past due balances that are patient responsible and any collection fees.
All returned checks will be subject to be re-deposited electronically without further notice and are subject to a processing fee of $25.00 or the state limit for any unpaid checks.
Our primary concern is that you receive the eye care you need. Your understanding of our fees and payment policies and your cooperation with our procedures will enable us to provide more satisfactory service to you. Should you have any questions regarding these matters, please speak with our business office staff at any location.
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