Financial Policies

We are committed to servicing your medical needs. We understand the complexities of medical insurance. We will facilitate the handling of medical claims by completing insurance forms for you and accepting direct payment from your insurance company (accepting assignment). In order to service your insurance needs we require your understanding of our office payment policy.

Please realize that:

1. We cannot guarantee payment of our claims. Some insurance companies arbitrarily select certain services that they will not cover. You will receive a monthly billing statement that will indicate any deductible and/or copayment amounts not covered by your carrier. Deductible and copayment amounts are the patient’s responsibility.

2. If you are a member of an HMO you must bring a referral authorization form with you to ensure payment of retinal services by your plan.

3. Filing of insurance claims is a courtesy that we extend to our patients. All charges are your responsibility from the date that the services are rendered. If payment problems arise, we encourage you to contact us promptly for assistance in the management of your account.
   

Medicare Policy and Regulations

We are participating Medicare providers and we submit claims to Medicare on behalf of our patients. Medicare sets the fees (the Medicare Fee Schedule) which physicians can charge Medicare beneficiaries.

Under Medicare Part B, physician services are reimbursed by Medicare at 80% of the Medicare Fee Schedule. The remaining 20% of the fee schedule, or the co–insurance, is the responsibility of the beneficiary. The beneficiary is also responsible for a $155 annual deductible which every Medicare B beneficiary must satisfy before payment may be made by Medicare for covered items and services.

Medicare regulations require that physicians collect both deductible and co–insurance amounts from their patients and/or their third party payers. Physicians and suppliers who are found to consistently and routinely waive the collection of the deductible and co–insurance from, or on behalf of their patients, are subject to criminal prosecution by the Department of Justice.

Managed Care Policy

We participate with many Managed Care programs. Patients who are members of any of the aforementioned Managed Care programs are responsible for obtaining a referral authorization form from their primary care physician for each visit to this office. The referral form must be given to our receptionist prior to the retinal examination. If it is determined that retinal diagnostic tests or surgery are needed, we will forward a referral authorization form to your primary care physician for signature prior to the testing and/or surgical date.

Please be aware that Managed Care patients are financially responsible for any services rendered without prior authorization.