Billing Policies and Authorization to Bill Insurance
Medical Billing is difficult to understand as soon as insurance is involved. Everyone wants to know how much patients will owe before the exam, even the doctor’s office. Insurance companies make this as complicated as possible, however Insight will work the best we can to learn and communicate this information before the exam, if requested. In many cases medical insurances cannot provide that clarity, and before a patient has met their deductible, this amount quoted will change. We will work to make things as clear and accurate as possible, we do ask our patients to be patient with all quotes that involve insurance. If you want to know how much an exam will cost the quickest, most accurate way, we can easily provide that if insurance is not used. In fact, those prices are posted in our lobby and website.
INSIGHT EYECARE’S BILLING & PAYMENT POLICIES:
1. COPAYS AND DEDUCTIBLE AMOUNTS:
We ask that payments be made at the time of your visit unless other arrangements have been made in advance. By signing our billing and policy agreement, I understand that Insight Eyecare does not set prices for copays and is required by contract with each insurance company to collect the copay and/or deductible amounts at every visit. I understand that copays and/or deductible amounts are required by insurance companies for each visit warranted. I understand that if I have not already paid my deductible for the current year, I will owe the full amount of my visit to Insight Eyecare based on the policies and prices set by my insurance company.
2. ASSIGNMENT OF PAYMENT:
Our payment policy also Our payment policy also requires that payments for services and materials are expected at the time of service for all patients. I hereby authorize direct payment of medical/vision benefits to Insight Eyecare for services rendered in person or at the practice. I understand that I am financially responsible for any balances not covered by my insurance plan.
3. MEDICAL INSURANCE VS. VISION PLAN:
If you only need an eye exam to make sure your eyes are healthy and get an updated glasses prescription, this exam would be covered under your vision plan. If your PCP refers you to us for a medical eye exam or if you have health concerns, such as diabetes, hypertension, lupus, high cholesterol, etc., this exam would be covered under your medical insurance. Some vision plans will allow us to bill the copay of a medical exam to them as secondary, but it is not a guarantee of payment.
4. DETERMINING COSTS
We don’t like surprises, and neither do you. Medical insurance plans that include vision benefits are usually contracted through a third party, such as VSP or Eyemed. Insight Eyecare contracts with almost all medical plans, but we are only contracted with a few vision plans. We ask patients to confirm vision and medical plan details such as member ID and group ID when an appointment is made. This allows time for our insurance team to confirm benefits before your exam, including whether or not we are in network with your plan(s). If you would like to know more about what is covered, your plan will release information to you (their member) more efficiently than they will to your provider. Please be aware that it is possible for insurance companies to reply 60-120 days later with different amounts than what they quoted at your exam date. I understand that I am responsible for the payments that my insurance instructs Insight Eyecare to charge me, regardless of when the insurance company makes that determination.
5. VISION PLAN LIMITATIONS:
Vision plans do not insure or cover medical exams, tests, or procedures. Vision plans cover basic exams, glasses prescription measurement called refractions, and may or may not cover standard glasses or contacts. Vision plans follow one of two models for the majority: copays and agreed upon discounts or flat fee paid towards whatever glasses or contacts you choose. Insight does not pick which of these models is used, that is determined by the plan the patient signed up for. Complex medical cases such as glaucoma, cataracts, and diabetes examinations may not be covered by vision plans and need to be billed to the medical plan. Please remember that if an insurance company is mandating Insight Eyecare to charge you more than our Insight Exam Package, you always have the right to pay outside of insurance. We are happy to discuss self-pay options within the rules that save you more money.
6. REFRACTIONS & OTHER NON-COVERED CHARGES:
A refraction is an essential part of an eye examination and is covered by vision plans, such as VSP and Vision Care Direct. However, since refractions are considered vision care, they are NOT covered by Medicare or most medical insurance plans. A refraction is required at your yearly eye exam, because it tells the doctor if you need corrective lenses, and if so, what power those lenses need to be. I understand that in order to receive a prescription for glasses, a refraction is required. I understand that if I do not have a vision plan or vision coverage through my medical plan, I will be financially responsible for the test.
*Insight Eyecare charges a fee of $40 for the refraction, whereas other local clinics charge up to $100 for this test.
7. CONVENIENCE FEE:
For the convenience of paying by card, a fee of 2.99% will be added automatically to all credit and debit card transactions. This fee does not apply to payments made by cash, check, or a health savings account. This is usual and customary for medical practices, including the State of Oklahoma, and others in the modern health industry. Please understand that Insight Eyecare pays the sales tax on all glasses and contacts but does not charge sales tax (10%) on service or materials. I understand that if paying by credit card, there will be an automatic 2.99% fee added to my total payment. I understand that I can avoid the 2.99% convenience fee by paying with check or check.
8. OUTSTANDING BALANCES:
It is our policy to render periodic statements for services on a monthly basis. In the event that statements for services are not paid within sixty (60) days from sending the first invoice, we reserve the right, at our option, to charge interest on the balance due, at a rate of 1.5% each month that the balance is not paid. We will send 3 statements via your preferred method of contact using the cell number, email address, and/or mailing address provided to us in your most recent paperwork. After the third statement, if no payment or arrangements have been made, we will attempt a phone call followed by a letter in the mail explaining that all remaining balances owed are now eligible to be sent to collections.
9. CONTACT LENS EXAMS:
In order to ensure contact lenses are fitting an eye properly without causing damage or vision loss, additional testing and examination is required. Contact lenses are either class 2 or 3 medical devices, which legally require certain safety practices to be used safely without long-term damage. As is normal in the eyecare industry, Insight eyecare charges a cornea and tear film analysis exam initially and annually in order to properly fit contact lenses. This additional exam is not included in a basic exam and begins at $60 and increases as the complexity of the case increases such as with astigmatism, multifocal, dry eye, or corneal disease. I understand that these additional fees for exams related to contact lenses are the patient’s responsibility and are additional to the complete exam that are paid each year.
10. NO-SHOW POLICY:
I understand that if I do not contact Insight Eyecare to cancel my appointment within 24 hours of the appointment time, Insight Eyecare may, at their discretion, charge up to a $50 cancellation fee that will not be paid by insurance. I understand I will be responsible for this charge.
BILLING INSURANCE AUTHORIZATION:
1. I understand that if I am a member of an HMO or PPO plan, I may need to have a valid referral from my PCP for each office visit. Please call our office in advance to make sure you have the necessary forms and authorization.
2. I authorize Insight Eyecare to release any medical or incidental information that may be necessary to bill my medical insurance and/or my vision plan.
3. I understand that some diagnoses/procedures require billing to my medical insurance and some to my vision plan, depending on current standards of practice. I authorize Insight Eyecare to bill services and materials to the insurance type that they deem proper. I understand that Insight Eyecare will work with me to determine my best options financially and medically
MEDICARE PATIENTS:
I request that payment of authorized Medicare benefits be made on my behalf to Insight Eyecare for any services furnished to me by its physicians. I authorize any holder of medical or other information about me to release to the Health Care Financing Administration and its agents any information needed to determine these benefits or benefits payable for related services. I request that payment of authorized “Medigap” benefits be made to Insight Eyecare for any services furnished to me by those physicians. I authorize any holder of medical information about me to release to my Medigap insurer any information needed to determine these benefits or the benefits payable for related services. I understand that I am financially responsible for any services or materials that I authorize not covered by Medicare.