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Payment Options

Understanding Your Payment & Insurance Options


At North Shore Eye Health & Wellness, your physical eye health is our top priority. As a Medical Eye Care Practice, this means that most visits are billed through your medical insurance—not vision plans.

We are not in-network with any vision plans, but if your plan offers out-of-network benefits, our team will gladly help you utilize them and guide you through the reimbursement process.

We know insurance can be confusing, so we’re here to help you understand your coverage and make the most of your benefits. Below is a breakdown of how different types of insurance apply to eye care.

Medical Insurance vs. Vision Plans


Vision Benefit Plans are designed for discounts on:

  • Routine eye exams for a glasses/contact lens prescription

  • Eyeglass frames, lenses, and contact lenses

  • Discounts on lens upgrades or materials


Vision plans cannot be used to cover any medical issues, even if they involve the eyes.


Medical Insurance (e.g., Anthem BCBS, Cigna, Aetna, Medicare) are utilized for care related to:

  • Diabetes, high blood pressure, high cholesterol

  • Eye diseases like glaucoma, cataracts, macular degeneration

  • Eye infections, dry eye, and allergy symptoms

  • Eye injuries or sudden vision changes


When a medical diagnosis or medical condition is present that affects your eyes we will always file the claim with your medical insurance, and the co-pays and deductibles for that insurance will apply.


Please Note: Medical insurance cannot be billed for routine vision exams for glasses or contacts or non-medical vision problems such as nearsightedness, farsightedness, and astigmatism. In some circumstances, some plans do have wellness benefits for the eyes. Our insurance team is more than happy to search for that benefit for you.


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Anthem
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What Happens During Your Visit

During your eye exam, your doctor will determine whether your visit is medical or vision-related based on your symptoms and diagnosis.


We always collect both your medical insurance and vision plan information to help guide this process and ensure the appropriate claim is submitted.

Please note: We are only able to bill one form of insurance per visit—either your medical or vision—not both. This is in accordance with insurance billing regulations.


We will always explain what’s being billed and why, so there are no surprises.


​​​​​​​Open Access Practice

Even as an out-of-network provider for vision plans, we’re proud to be an Open Access Practice—meaning:


  • You’ll still receive the high-quality, personalized care we’re known for

  • We can help you access out-of-network reimbursement from your vision plan

  • We offer upfront, prompt pay discounts when applicable


It’s all part of our commitment to making expert eye care as accessible as possible.


Good Faith Estimates

If you do not have insurance, or choose not to use it, you are entitled to a Good Faith Estimate of costs before receiving care.


This includes:

  • Eye exams and diagnostics

  • Prescriptions or procedures

  • Eyewear or medical supplies


We’ll provide this estimate in writing, and you can also request one before scheduling your visit.


Learn more: www.cms.gov/nosurprises


Note: Payment for materials (eyeglasses, contact lenses) is due in full before lab orders are placed. A quote and invoice will be provided in advance.


Payment Options

We accept the following forms of payment:

  • Cash

  • Check

  • Visa, Mastercard, Discover, Amex (card payments do include a 3.5% processing fee)

  • CareCredit


We’re happy to discuss any costs with you in advance. Our goal is to ensure you feel comfortable and informed every step of the way.


FSA & HSA

If you have a Flexible Spending Account (FSA) or Health Savings Account (HSA), you can use it for:

  • Medical eye exams

  • Glasses and contact lenses

  • Elective services like LASIK or CRT

  • Vision Therapy


Check with your benefits provider to confirm eligibility.


Still Have Questions?

Call us at (262) 421-4412—our team is happy to help!

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