Paying for Your Eye Care Needs
Healthcare Insurance
Kadrmas Eye Care New England works with over 40 insurance companies to provide you care. Please call us at 1-508-746-8600 to find out if we accept your insurance carrier and your specific insurance plan.
Understanding Your Healthcare Insurance and Medical Benefits
It is important to review your healthcare insurance policy and understand your coverage to avoid surprises. Make sure you know your patient commitment or responsibility and how it may impact you and your out-of-pocket costs. Understanding your insurance coverage can help relieve some of the stress associated with visiting a medical specialist such as an ophthalmologist. We outline some of the main components of patient responsibility below. Of course, please call your insurance company directly using the number on the back of your insurance card if you have any questions or for more information about your specific policy and plan.
Deductibles
Many insurance policies have a deductible amount that you as the patient must pay before they the carrier will cover your medical claims or expenses. Be sure you know the amount of your deductible and how much you have paid towards it to avoid receiving unexpected medical bills. Providers will often request that you pay this amount at the time of service, up until which time your entire deductible has been met. Even Medicare has a deductible that begins in January, and supplemental insurance policies may not cover your deductible.
Many insurance policies have a deductible amount that you as the patient must pay before they the carrier will cover your medical claims or expenses. Be sure you know the amount of your deductible and how much you have paid towards it to avoid receiving unexpected medical bills. Providers will often request that you pay this amount at the time of service, up until which time your entire deductible has been met. Even Medicare has a deductible that begins in January, and supplemental insurance policies may not cover your deductible.
Co-payments (Co-pays)
Your insurance policy may also have a co-payment that is due at the time of service. Providers will ask you to pay your co-pay when you arrive at the office. Be sure you know your co-payment amount for both primary care physicians and specialists so that you are prepared to pay it when you visit your doctor. Your co-payment may be higher for a specialist visit than for a primary care visit. As insurance costs rise, insurance companies offer consumers different policies with varied co-pay rates to keep premiums lower. Often employers will change their health insurance plans to help keep costs down for their employees, but frequently this can mean higher co-payments for you the patient. If you do not know the amount of your co-payment, you can typically find it listed on your insurance card.
Your insurance policy may also have a co-payment that is due at the time of service. Providers will ask you to pay your co-pay when you arrive at the office. Be sure you know your co-payment amount for both primary care physicians and specialists so that you are prepared to pay it when you visit your doctor. Your co-payment may be higher for a specialist visit than for a primary care visit. As insurance costs rise, insurance companies offer consumers different policies with varied co-pay rates to keep premiums lower. Often employers will change their health insurance plans to help keep costs down for their employees, but frequently this can mean higher co-payments for you the patient. If you do not know the amount of your co-payment, you can typically find it listed on your insurance card.
Referrals and Prior Authorizations
Many insurance plans will require patients to obtain an insurance referral (often simply called a referral) from their primary care provider / physician (PCP). Be sure you know whether your plan requires you to get a referral from your PCP before seeing a specialist. If you need to see a specialist and your plan requires a referral, it is important that you visit your PCP at least once per year to get your necessary referral(s). Some insurance plans and / or medical groups will not allow you to see an out-of-network specialist. Be sure you know if your PCP and your insurance plan allow you to see a particular specialist before making an appointment with the specialist. It is your responsibility as the patient to request and obtain the necessary referral from your PCP prior to your appointment.
Many insurance plans will require patients to obtain an insurance referral (often simply called a referral) from their primary care provider / physician (PCP). Be sure you know whether your plan requires you to get a referral from your PCP before seeing a specialist. If you need to see a specialist and your plan requires a referral, it is important that you visit your PCP at least once per year to get your necessary referral(s). Some insurance plans and / or medical groups will not allow you to see an out-of-network specialist. Be sure you know if your PCP and your insurance plan allow you to see a particular specialist before making an appointment with the specialist. It is your responsibility as the patient to request and obtain the necessary referral from your PCP prior to your appointment.
Networks
Be sure you know if your insurance plan has network limitations. Many carriers have limited network plans. You should know whether or not you are required to see in-network doctors as outlined by your insurance carrier and plan. Any medical service performed by an out-of-network provider is your responsibility as the patient. Many PCPs belong to limited medical networks or groups and will only authorize appointments and referrals within their network. It is your responsibility as the patient to understand your network limitations.
Be sure you know if your insurance plan has network limitations. Many carriers have limited network plans. You should know whether or not you are required to see in-network doctors as outlined by your insurance carrier and plan. Any medical service performed by an out-of-network provider is your responsibility as the patient. Many PCPs belong to limited medical networks or groups and will only authorize appointments and referrals within their network. It is your responsibility as the patient to understand your network limitations.
Inactive Policy and Lapsed Benefits
Always pay careful attention to the effective dates of your insurance policy. Every policy has an effective date and an expiration date. Before making a doctors appointment, be sure that you are covered for the intended date of service. Insurance policies to do not have a retro-active start date for coverage.
Always pay careful attention to the effective dates of your insurance policy. Every policy has an effective date and an expiration date. Before making a doctors appointment, be sure that you are covered for the intended date of service. Insurance policies to do not have a retro-active start date for coverage.
Refractions
Vision plans cover routine eye exams only and are not used for medical visits with either an optometrist or an ophthalmologist. Refractions are covered with routine eye exams. Refractions done in a medical appointment are typically not covered by medical insurance. As many types of vision issues are caused by medical conditions, the refraction portion of the exam may be your responsibility as the patient and payable at the time the service is performed.
Vision plans cover routine eye exams only and are not used for medical visits with either an optometrist or an ophthalmologist. Refractions are covered with routine eye exams. Refractions done in a medical appointment are typically not covered by medical insurance. As many types of vision issues are caused by medical conditions, the refraction portion of the exam may be your responsibility as the patient and payable at the time the service is performed.
Flexible Spending and Healthcare Savings Accounts
If you have a health savings plan of any kind, be sure to understand how to access those funds for your covered medical charges. Know the limit, and be sure to save receipts and keep track of spending from your account. Knowing your account's plan, how it works, how much you have spent, and your balance for the remainder of the year can alleviate confusion and frustration and may save you money.
If you have a health savings plan of any kind, be sure to understand how to access those funds for your covered medical charges. Know the limit, and be sure to save receipts and keep track of spending from your account. Knowing your account's plan, how it works, how much you have spent, and your balance for the remainder of the year can alleviate confusion and frustration and may save you money.
Questions about Healthcare Insurance and Medical Benefits
If you have any questions about your healthcare insurance or medical benefits, please contact your insurance company directly. They will be able to give you the most information about your plan, policy, coverage, benefits, and out-of-pocket costs such as deductible and co-payments. In addition, they will be able to confirm whether our ophthalmologists are considered in-network for your plan. After speaking with your insurance company and confirming that our doctors will be able to care for you under your insurance plan, please do not hesitate to call us at 508-746-8600 with any questions pertaining to your eye care at Kadrmas Eye Care New England.