At Professional Eyecare Centers, our goal is to ensure that you receive the maximum benefit that your insurance provides to you.
We take the extra step to verify your eligibility for you before you come in for your exam, to ensure that you receive the coverage and services that you are entitled to.
Our insurance specialist will take the time to explain your insurance benefits to you, submit your claim, and assist you in resolving any issues that may result with your insurance company.
When you arrive for your exam, please be prepared to show all current insurance cards that you carry. We will always take a copy of your medical insurance card as well as your vision insurance information, if you carry both. During an eye exam, the doctor may discover a medical condition that requires more testing, and this will usually be covered by your medical insurance. We will submit your medical claims as well as your vision claims for you.
COMMON INSURANCE TERMS AND WHAT THEY MEAN
Deductible: The deductible refers to the amount of money that the insured would need to pay before any benefits from the insurance policy can be used. This is usually a yearly amount so when the policy starts again, usually after a year, the deductible would be in effect again. Usually there are separate individual deductible amounts and total family deductible amounts.
Co-Insurance: This is usually a percentage amount that is the insured’s responsibility. A common co-insurance split is 80/20. This means that the insurance company will pay 80% of the procedure and the insured is required to pay the other 20%.
Co-Pay: The co-payment is a fixed amount that the insured is required to pay at the time of service. It is usually required for basic doctor visits and when purchasing prescription medications.
Out-of-Pocket: This is the cost one would pay out of their own pocket. An out of pocket expense can refer to how much the co-payment, coinsurance, or deductible is. Also, when the term annual out-of-pocket maximum is used, that is referring to how much the insured would have to pay for the whole year out of their pocket, excluding premiums.
Lifetime Maximum: This is the amount of money the health insurance policy will pay for the entire life. Individual and family lifetime maximums may be different.
Exclusions: Procedures that the insurance policy will not cover.
Coordination of benefits: If the insured has available two or more sources that would cover payment for certain conditions, such as being under a spouse’s insurance plan along with their own, the insurance company would not pay double benefits. In this case, the health insurance company would coordinate benefits to make sure each plan pays a portion of the service.
All insurance policies are not the same. Please check with your individual insurance company regarding the coverage that is specific to your own policy.