@Btown Eyecare

Billing Information

At B-Town Eyecare, our goal is to provide you with a wonderful experience with our office. At times medical insurance and vision plans make healthcare confusing. Fortunately, we are experts at navigating the insurance and vision plan quagmire. We accept several types of vision insurance, cash, checks, Care Credit, and most credit cards. We inform our patients about exam and treatment costs before your appointment. Often this will occur days before your visit. Getting this information to us as soon as possible helps us help you successfully navigate potential insurance questions.

Tips on Using Third Party Payors

If your insurance company is not listed below, we may still take your plan, feel free to call us. We will happy to call your insurance company and check on the benefits available. In most cases, we will need some or all of the following:

  • Cardholder’s complete legal name
  • Patient’s complete legal name
  • Patient’s date of birth
  • Plan name
  • Group name 

We are Providers of the Following Vision Plans: 

  • VSP – Vision Services Plan
  • NBN – Northwest Benefit
  • Davis Vision 
  • EyeMed – coming soon! 

We will be happy to file your insurance claim forms for your vision and/or medical benefits as designated by your insurance company. We are happy to provide this service without any additional charge to you. We go to great lengths to verify the amount and type of coverage you are allowed under your plan. We can quote your estimated coverage, however, the final determination of your benefits will not occur until your insurance company receives and approves your claim.

Please bring the insurance card to your visit.

Vision Plan or Medical Insurance?

Most people have medical insurance and/or a vision plan. They are very different in terms of the services they cover and it is important for you to understand these differences. All eye doctors in the U.S. are obligated to follow these laws and eye doctors are the only medical specialty that is governed by two different sets of third party reimbursement rules. In many cases there is no way to know prior to the examination which type of insurance will be applicable.

How is medical insurance used for a visit to an eye doctor?

When the reason for the office visit is a medical condition such as diabetes, cataracts, dry eyes, allergic eyes, floaters, hypertension, retina disorders, glaucoma, blepharitis, conjunctivitis, red eyes, irritated eyes, eye pain, etc. or a complaint, sign or symptom related to a medical condition, examination of patients using medications with potential eye side effects, such as steroid medications, arthritis medications, etc. we are required by law to file the exam/office visit charges to a patient’s medical insurance (e.g. Premera, Regence, United Health, Aetna, Tricare, etc.).  Additionally, if the office visit was recommended by a physician the office visit is billed to the medical insurance carrier. 

By law, we cannot file the claim to your vision plan in those situations. 

Please note: Medical insurance will NOT cover an update for your glasses or contact lens prescription! When you call in to make your next appointment with the eye doctor, make sure to explain the purpose of your visit so that we bill the appropriate insurance. Additionally, please always bring your insurance card(s) with you to every appointment.

What is a Vision Plan?

A vision plan (e.g. VSP, Davis, NBN etc) is designed to determine a prescription for glasses or contacts and pay for glasses and/or contacts. Most vision insurance plans include the following benefits: Basic eye exams, eyeglass frames, eyeglass lenses, and contact lenses. Check with your plan to see if your benefits cover you once every year or once every two years. 

Vision plans are also not designed to pay for diagnosis or treatment of medical conditions. Vision plans do allow for screenings of eye diseases if there are no signs, symptoms or complaints or previous history of problems. However, if there are complaints, signs symptoms, previous eye disorder diagnosis, or physician recommended exam, then vision plans DO NOT cover the office visit. Medical insurance would then be used for that type of office visit.

Questions & Answers

Will Medicare cover my eye exam for new glasses or contact lenses?

Unfortunately, no. Medicare does not cover routine eye exams where your glasses or contact lens prescription is checked. Medicare will only pay for eye exams relating to medical complaints. Medicare also does not pay for a refraction (vision test to determine your glasses prescription).  

Can I use my vision insurance and my medical insurance for a joint exam on the same day?

No. By law, we cannot bill two different types of insurance on one day. There are two alternatives.

First, we can always schedule your medical and vision visits on separate days, allowing us to bill your insurances on different days. You may have to go through some repetitive parts of the exam on those days because by law there are certain things the eye doctor must document at every visit.

If you need to schedule your medical and vision visits on the same day, another option is billing your medical insurance for the medical exam (don’t forget, this may include a copayment at the time of your visit), and paying the additional flat rate for a refraction ($75).

Why is insurance so complicated?

Good question! We don’t make the rules, we just follow them. Every time you schedule an exam, we contact your insurance company and ask them how much we should charge for the exam. You can also do this by calling the phone number on the back of your insurance card or looking up your insurance policy details online. Ultimately it is your responsibility to understand the policies of your insurance companies, both medical and vision. Please call us if you have any remaining questions!

Collection and Fee Amounts

All U.S. doctors are required by law to collect your co-pay (we are classified as specialists for co-pay amount), co-insurance, deductible and fees for non-covered services and will do that at the time of your office visit.

The amount of our fee for covered services is dictated by the insurance company and we often don’t know the exact amount until the claim is adjudicated by the insurance company. Appropriate fee discounts will be included in the fees to arrive at the insurance “allowable charge”.

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