At North Shore Eye Health and Wellness, we are a MEDICAL EYE CARE OFFICE. We diagnose, treat, and manage the medical health of the eye. This means that in most circumstances, we will bill your medical insurance for your eye health physical and office visits.
We often have patients that have both Vision Benefits (for example, VSP or EyeMed) and Medical Insurance (for example, Anthem BCBS, Cigna, Aetna, or Medicare). They are very different in terms of the services they cover, and it's important for our patients to understand these differences. Unfortunately, the insurance world is a confusing one but we are here to help and answer any questions that you may have!
Vision benefit plans are typically supplements and discounts and are designed mainly to cover determining a prescription for glasses, to help pay for glasses or contact lenses, and to cover a yearly, vision screening of the eyes in a healthy patient that has no particular problems or symptoms. These benefits do not cover medical conditions, injuries, and/or treatments. The main benefit of these types of plans is that they provide for discounted fees on materials, including frames, lenses, and/or contact lens materials. Our staff will assist with determining your coverage in order to maximize your benefit!
Medical insurance is designed to cover you when you have a medical condition, including ones that affect your eyes, eye injuries, eye infections, or need additional treatment or medical procedures to be performed. This can be an overall health condition (even controlled ones) such as Diabetes, Blood Pressure, Cholesterol, or an eye-specific problem, such as Glaucoma or Cataracts. Medical insurance does not cover vision screenings for glasses (refractions), or non-medical vision problems such as nearsightedness, farsightedness, and astigmatism.
When a medical diagnosis or medical condition is present that affects your eyes, such as high blood pressure, high cholesterol, or diabetes, to name just a few examples, or you have an eye disease or eye problems such as an infection (pink eye), dry eyes, allergy, or cataracts, we will always file the claim with your medical insurance, and the co-pays and deductibles for that insurance will apply.
At North Shore Eye Health and Wellness, we want to help maximize your eye health and material benefits. As such, we have elected to serve you as an open access practice. This means that we can provide you with the high quality, concierge, medical eye care service you deserve, and help you gain access to materials benefits, even if we are out of network for your vision plan!
Your eye health physical will determine which insurance category must be billed. Therefore, we always ask for insurance information for both your Vision Benefit and your Medical Insurance. We will always keep you informed as to which insurance form will be utilized (and why) and will make every attempt to maximize your coverage.
We are proud to be on a variety of medical insurance panels. In the event that we are not in-network for your medical insurance or vision benefit plan, as an open access practice we will help you access out-of-network reimbursement for care and provide an additional up-front, prompt pay discount! A win-win situation!
If you do not have insurance, or you are electing not to use insurance for your eye care services, you have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost.
Under the law, health care providers need to give patients who don't have insurance or who are not using insurance an estimate of the bill for medical items and services.
You have the right to recieve a Good Faith Estimate for the total expected cost of any nonemergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
*Please note, for materials (i.e. eyeglass frames, lenses, contact lenses) a verbal quote will be provided, followed by an invoice before proceeding with ordering the device/material. Payment is due in full before the lab order is placed.
We understand that cost is a concern when evaluating eye health care providers. We do not want cost to be an obstacle to maintaining proper eye health and good vision. We accept various forms of payment and are able to discuss financing options with you prior to any examination. At North Shore Eye Health and Wellness, we also accept cash, check, Visa, Mastercard, Discover and Care Credit. Call (262) 421-4412 today to schedule your eye exam today.
Many employers offer Flexible Spending Account (FSA) options and/or Health Savings Accounts (HSA) to employees. These plans are able to be used to pay for medical eye care services, materials, and elective procedures like LASIK or CRT. Check with the benefits administrator at your work to see if you are eligible for this type of program. FSAs can typically be used in conjunction with your insurance plan to offset any out-of-pocket costs on your behalf.