There are many plans within insurance plans now. It is your responsibility to determine if authorization is necessary and what your insurance does and does not cover prior to your appointment. We participate with several key insurers: Blue Cross Blue Shield, Blue Care Network, Priority Health, Medicare, Priority Health Medicaid, Medicaid, Molina Medicaid and McLaren Medicaid. It may be there is a plan within the plans we do accept that we don’t participate with. It is your responsibility to determine participation status prior to your appointment.
We do not participate with Medicare plans outside of the traditional government Medicare. We do not participate with any insurer not listed. We do not participate with other Medicaid plans not listed. Therefore, payment is due at the conclusion of your visit and we will not bill your insurance carrier if we do not participate.
If your child has been approved for Children's Special Health Service (CSHS), Dr. Droste and Dr. Peters must be listed as providers prior to your visit. If they are not listed with CSHS at the time of your visit, payment will be expected at the conclusion of your visit.
It is important to understand that there may be services which are necessary for diagnosis and treatment that your insurance does not cover. In this event, you will be notified at check in and this fee will be collected at the end of your appointment along with co-pays, deductibles and any past due balances. Collecting all amounts due at the end of the visit is necessary to keep medical costs down. Please be advised that provider participation with your insurance does not mean that 100% of your visit will be covered. Please make note that Priority Health has determined refractions (see below) are the patient's responsibility. Refractions have never been a covered service by Medicare and Medicare type plans therefore; we do not bill Medicare for this service. We encourage you to review your coverage with your insurer prior to your appointment.
Questions regarding payment plans can be addressed to our billing department prior to your appointment. Payment plans will be created using the PaySpan method. A credit card will be required and a designated amount will be withdrawn on the 15th of each month until your payment plan is satisfied.
Please be prepared to pay with cash, check, or credit card. We accept Visa, Master Card and American Express. Our preferred method of payment is by credit card. You will be asked to choose your method of payment at check in. We do not balance bill. We do not do statement mailings for balance owing.
Refraction
Refractions are not optional. Refraction is necessary to determine values to provide treatment.
(This definition is from the American Academy of Pediatric Ophthalmology and Strabismus: policy statement.)
Childhood eye disease and/or abnormalities require thorough medical and ophthalmologic evaluation. Many times additional diagnostic testing is required such as refraction. Refraction is the determination of the refractive state including prescription of any necessary corrective lens (es).
Refractions are needed to properly diagnose and effectively treat the differences in refractive error between the right and left eye which may be the cause of lazy eye (Amblyopia) or misalignment of the eyes (Strabismus). Left untreated, these conditions may lead to permanent, irreversible visual loss that cannot be treatable with glasses, surgery, medicines or lasers.
Refractions are a medical necessity in children and are not included as a component of an ophthalmology procedure code or an Evaluation and Management exam procedure code.
The American Academy of Pediatric Ophthalmology and Strabismus (AAPOS) adopts the following policy: (1) Refractions in children are a medical necessity and (2) the cost for refractions in children should be considered as a separate and reimbursable service to be paid for either by the third party payer or the patient.
Approved October 23, 1999
CPT-copyright by the American Medical Association
The above information is true for the adult population with ocular motility diagnoses (diplopia and strabismus).
Authorizations
Authorizations may be part of your insurance plan requirement. This is your responsibility to determine if this applies and to secure the authorization or referral before your visit. You may want to discuss this with the physician that is referring you to our practice. Unfortunately, we cannot see a scheduled patient if there is no authorization or referral for the visit. You may choose to continue with the visit and pay for the visit with the understanding that we cannot obtain authorization after your visit and we will not bill your insurance.
Cancellations / No Show Visits
We are mindful of the costs of health care as a provider. Therefore, we ask that if you are unable to keep your appointment, we are given no less than a 24 hour notice of cancellation. Patients that do not show for their appointment will incur a $50 charge. Appointments that are broken less than 24 hours of the appointed time will incur a fee of $50. There are patients that need your appointment time if you are unable to keep your appointment.
Auto Pay Program
PaySpan is the credit card processor. Credit cards are the preferred method of payment. You will be asked to present your credit card at check-out at which time we will swipe your card for payment. You may elect to retain your card on file for use of payment when we receive your explanation of benefit from your insurance company indicating additional amounts owed for deductible, coinsurance, co- pay and non-covered services. We can process this payment immediately without sending statements with your card on file. This process will provide cost savings to you and our practice. We do not retain or have access to credit card information. Your credit card may be set to “authorize” by your bank or the bank of your credit card. This is the same process used when swiping your credit card at the gas pump, when you make purchases at retailers or when making on-line payments. When using a debit card to make your payment an authorization is used with the debit card and your bank may hold funds for up to 72 hours. The authorization process is between your credit card company and your bank. Again, at no time do we have access to your credit card information.