Eye Care Specialists accepts most major vision and medical insurances and HMOs, including, but not limited to:
If you have dry, itchy and/or burning eyes; cloudy vision; pain; an infection; or any other ocular-related medical complaint or eye condition, your medical insurance can be billed for your exam. Depending on your policy, this may leave you with just a co-payment fee rather than the cost of the full exam and treatment. However, medical insurance does not cover "routine" eye exams, glasses or contact lenses. At Eye Care Specialists, the current charge for a comprehensive, dilated eye exam with a prescription for new corrective lenses is $166.
Since coverage varies with each individual insurance company, we may not know and cannot guarantee whether a particular service will be covered by your contract (including even those considered medically necessary and appropriate). As such, we suggest that you refer to your insurance member handbook, check with your employer, or call your insurance company with specific coverage questions.
You are required to pay your co-pay when you check in for your appointment. You will be mailed a bill later for your deductibles, co-insurance and any non-covered services.
If you do not have insurance, you will be notified at the time of scheduling your appointment what percentage of the fee will be due upon checking in at our office. You will then be sent a bill within a month for the remainder of the amount.
If you don't have insurance, a bill will be sent within a month of your visit. If you verified your insurance information when you registered, a bill will be sent after any of the following three situations:
If, however, full payment has been received from you or your insurance carrier, you will not be sent a bill.
Your account balance is due and payable within 30 days of receipt of your statement. (However, we reserve the right to require payment at the time of service from any patient who has an overdue account.)
Please feel free to contact our Billing Department at 414-298-0054 with any questions about your bill or financial situation.
Medicare sets maximum allowable amounts that it will pay for a service or medical procedure. Medicare then pays 80 percent of its allowed fee—once your annual deductible has been met. As an added benefit to our patients, Eye Care Specialists accepts assignment for Medicare on all covered services. This means that we will accept Medicare as payment in full—once your deductible and co-insurance requirements have been met. Medicare will pay for an eye exam if you have a medical diagnosis. (such as cataracts, dry eyes, tearing, headaches, glaucoma, diabetes, etc.)
If you have co-insurance, depending on the policy, it may pay up to 20 percent of the remaining expenses. Therefore, your out-of-pocket expense, with co-insurance (if your annual Medicare deductible has been met) could be zero.
If you do not have supplemental insurance, your cost will be the annual Medicare Part B deductible ($147 in 2013), plus the 20 percent of expenses not covered by Medicare.
For your convenience, our office staff will fill out and submit all of your Medicare and insurances form. The following are the most common questions we receive regarding Medicare coverage. If you have further concerns, please contact our Billing Department at 414-298-0054.
A "refraction" is the procedure by which the amount of optical error of the eye (nearsightedness, farsightedness and/or astigmatism) is measured to determine the correct strength/power to be used in an eyeglass or contact lens prescription. This is typically the part of an eye examination when the patient is asked which lens choices seems better or clearer ("one or two," etc.). Medicare does not presently cover this testing. The cost is $28.
No. You will receive a Medicare explanation of benefits in the mail. Keep this copy for your records. Our staff will then submit one secondary insurance claim form for you. For this reason, it is important to provide accurate insurance information, including the exact address of your insurance company.