Billing and Insurance Policies
The best medical care can be provided only on the basis of mutual understanding. We encourage you to discuss any questions you may have regarding our policies with our billing staff.
We prefer that all patients pay at the time of their visit. Services covered by an insurance company will be billed to them. If you have a balance to pay, a statement will be mailed to you that is due within 30 days. Charges and payments for services received during the last few days before your billing date may appear on a statement the following month.
Exam Fee and Refractions
During routine eye examinations medical problems are sometimes discovered. If a medical problem is found, we may in some cases be able to bill your medical insurance. It is mandatory that we divide the bill for your visit into a medical portion, which we can bill to your medical insurance, and refraction (eye glass prescribing) portion. The refraction fee is $16.00. This is not covered by Medicare or most major medical insurances. This fee will be collected at the time of your exam. Should your major medical insurance pay for the refraction, you will receive a refund. Contact lens fittings are not part of a routine exam. This is an extra service and there is a separate charge for this.
We cannot tell you in advance if your particular insurance will cover your examination and treatment by our office. Insurance companies sell a variety of different plans to different employers. It is your responsibility to contact your insurance company or employer to determine your benefits. We cannot accept responsibility for negotiating claims with insurance companies. You are responsible for payment of your medical care within a reasonable time, regardless of the status of a claim. Services not covered by your insurance are your responsibility.
When your insurance specifies a co-payment (indicated on the insurance identification card), this payment must be made at the time of your visit. We prefer to collect the co-pay at the end of your visit along with the refraction charge. This way you will only need to pay once. (Note: Not all exams require a refraction, therefore we need to wait until you check out to see if you received this service.)
Some health maintenance organization (HMO) plans require you to obtain a referral or prior-authorization for services from your primary care provider (internist, family practitioner, pediatrician, etc.). This is your responsibility. This is required by your insurance before you visit our office, even when the visit is for an urgent problem. If you have questions contact your insurer or the office of your primary care provider.
Payment in full is expected at the time of delivery for all eyeglasses, contact lenses and supplies. Upon your request we will bill your insurance. It is your responsibility to follow up with your insurance on the status of the claim. If your insurance company also pays the claim, you will receive a refund.
For your convenience, we accept Visa and MasterCard.
We are participating providers under Medicare. This means we accept the fees set by Medicare for medical services covered by the Medicare program, including surgery. Medicare only pays 80% of the each of the fees that they set. The remaining 20% is the patient’s responsibility. If you have a secondary insurance, we will bill them the remaining 20%. The patient is responsible for any co-pays, deductibles and services not covered by Medicare or the insurance, such as refractions. A refraction is the measurement of the eyeglass prescription. Medicare considers testing for eyeglass prescriptions to be routine vision care, not medical care, and therefore does not cover this service. This will be your responsibility at the time of visit.
The Eye Clinic of Racine and our Optical Department participate in the Medicaid programs for Wisconsin. Medicaid guidelines require us to collect co-pays at the time of your visit. Most co-pays are $2.00. Medicaid does not cover some refractive services such as contact lenses and contact lens fittings.
(Note: If you have a managed care (HMO) Medicaid, we cannot see you for routine exams. Also, our Optical Department does not participate with Managed Care (HMO) Medicaid.)
If you have further questions, please contact an Eye Clinic Bookkeeper at: (262) 637-9615. Kenosha toll-free at: (262) 658-8489