Insurance & Billing
Insurance & Financial Aid Program Participation
Drs. Brett Rhode, Daniel Ferguson, Daniel Paskowitz, Michael Raciti, and David Scheidt accept most major medical insurances and HMOs, including, but not limited to:
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Managed Care Providers (HMOs, PPOs, etc.)
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Medical Insurance Programs (United Healthcare, Humana, Anthem Blue Cross, etc.)
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Medicare
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American Academy of Ophthalmology's EyeCare America®: Seniors EyeCare Program, Diabetes EyeCare Program, Glaucoma EyeCare Program and Children's EyeCare Program
Common Billing & Insurance Coverage Questions
What is the cost of a complete eye exam?
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 $179.
How can I know what eye-related services my insurance company will cover?
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.
Do I have to pay my co-payment at the time of registration?
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.
What if I don't have insurance?
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.
When will I receive a bill?
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:
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Your insurance company has denied the claim.
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Your insurance company has paid the claim, and you still have a co-insurance, deductible or non-covered service payment to make.
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Your insurance company has not responded to the claim. If, however, full payment has been received from you or your insurance carrier, you will not be sent a bill.
When is my payment due?
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.)
Who can I talk to regarding questions about my bill?
Please feel free to contact our Billing Department at 414-298-0054 with any questions about your bill or financial situation.
Common Medicare Coverage Questions
Does Eye Care Specialists accept Medicare?
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 ($179 in 2020), 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 insurance forms. 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.
What is a "refraction," and does Medicare cover it?
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 $30.
When I hear from Medicare, should I send the information to my secondary insurance company?
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.