Insurance Information
Information About In-Network Plans and General Insurance Information
We are all committed to enhancing the quality of your care and overall experience. One way of achieving this is by clearly communicating our policies and clear expectations of compliance with them. As there are countless insurance policies/plans, we cannot anticipate the nuances of every policy. We highly recommend and expect you to know what and how your insurance covers your vision health.
The following information is provided to help you understand how your insurance works, what your responsibilities are in relation to our financial policies, and some of the reasons for them.
In Network with Most Insurances
Aetna (including Aetna-CVS)
Blue Cross Blue Shield of North Carolina
Cigna
First Health
Humana
Medcost
Medicare
United Healthcare
Please note that we are currently out-of-network with Vision Plans (Eyemed, VSP, etc.) and most Individual Exchange/Affordable Care Act (Obamacare) plans, such as Blue Home and United Healthcare Essential and Standard plans.
We are always looking to increase access to our eye care services. If your plan isn’t listed, please contact our office. The health insurance market changes rapidly, and specific coverage questions should be directed to our staff or your insurance company.
Additionally, we accept patients who are self-pay. Payment is required at the time of service.
Insurance Info
Deductible
A deductible is the initial amount of money an insured has to pay (out of pocket) before any benefits from the health insurance policy can be used. Most deductibles renew on an annual basis and begin in January with services covered under the calendar year. However, there are others that renew mid-year like in July. Some insurance carriers allow for a “last quarter carryover” whereby services during the last quarter of a year can be carried over and applied to the next year’s deductible. If you are unsure which you have, contact your insurance agent.
Out-Of-Network
A provider who has not contracted with your insurance company for reimbursement at a negotiated rate is referred to as an “out-of-network” provider. Some health plans, e.g. HMOs, do not reimburse out-of-network providers at all, which means that as the patient, you would be responsible for the full amount charged by your doctor. Other health plans offer coverage for out-of-network providers, but your patient responsibility would likely be higher than it would be if you were seeing an in-network provider.
Co-Payment
A co-payment is a fixed amount you are required to pay for each medical service you receive, regardless of the cost of the service. Unlike a deductible that’s usually paid once a year, a co-pay is paid each time a healthcare service is rendered.
Co-Insurance
Unlike the fixed amount of a co-pay, coinsurance is a percentage of the provider’s cost of service after the deductible has been met. Co-insurance continues to be paid until you reach your “out-of-pocket” maximum. After that, the insurance company will pay for all covered services up to the policy’s maximum for the remainder of the year. Out-of-pocket maximum’s have a wide range of possibilities depending upon the insurance - from $1000 to $5000 or more.
