WEA Insurance Form

INSURANCE POLICY

Medical Insurance Carriers – Medicare, United Health Care, Blue Cross, Aetna, Cigna, etc. We bill medical insurance when you present a medical related complaint such as: itch, burn, dryness, redness, eye pain, etc. that may or may not require treatment and monitoring. We will also bill your medical insurance carrier for medical diagnosis/findings such as Diabetes, Glaucoma, Cataracts, Floaters, Macular Degeneration, etc.

• HMO Policies: If an authorization/referral for your visit cannot be obtained, you will be billed for the services rendered.
• If you present with both a vision complaint and a medical complaint, we will bill to the appropriate insurance as indicated in your insurance by-laws.

Medicare Notice - We are Medicare participating providers; therefore, we will bill Medicare directly. However, as with any insurance carrier, you will be responsible at the time of services for payment of:

• The annual deductible: $198.00
• Co-payments/Coinsurance: 20% of allowable procedures if deductible not met.
• Charges for non-covered services: Example: $39.00 Refraction fee (may not be covered by Medicare supplement plan and/or vision discount plan).
• Refraction is required to determine your best corrected vision. We will conduct refraction whether you wear glasses or not.

You will also be asked to sign an Advanced Beneficiary Notice (ABN) form in the event a service is provided, which we know is not covered by Medicare or your supplemental insurance.

Vision/Routine Insurance – VSP, Superior, Eyemed, Spectera, etc. These discount plans are billed for routine eye exams, glasses or contacts lenses. They do not cover medical related complaints or conditions. Most vision discount plans require an authorization before your services are rendered. If we cannot obtain an authorization, you will be responsible to pay for both professional services as well as eye wear materials.