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Insurance/Financial Policies

Insurance Plans Accepted

  • AARP 
  • Aetna US Healthcare HMO & PPO Plans 
  • Blue Cross/Blue Shield Federal 
  • Blue Cross/Blue Shield – HMO Plans 
  • Blue Cross/Blue Shield of MD – PPO Plans 
  • Cigna PPO & HMO Plans
  • Coventry 
  • Johns Hopkins, Johns Hopkins Advantage MD 
  • Humana Group Health Plan 
  • Informed 
  • Bravo 
  • MedStar Family Choice
  • Medicare 
  • Medicare Managed Care: Evercare 
  • Medical Assistance 
  • Managed Care: Amerigroup, Priority Partners, MD PHY. CARE, United MA 
  • MDIPA 
  • Optimum Choice 
  • Priority Partners
  • Private Health Care Systems 
  • Tricare: Tricare for Life, Tricare Prime, Johns Hopkins - US Family Health 
  • United Health Care 
  • All commercial indemnity plans

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.

Benefits Verification

We will verify your insurance benefits prior to each visit.  The Benefits Verification Team will confirm your balance, copay amount, remaining deductible amount, and any coinsurnace that may be required by your plan.  We will call you to discuss these amounts, the expected cost of your upcoming visit, and the amount we will collect from you for your visit.

Upon checking in for your visit, we will collect your required copay and any outstanding balance due.  If you have a deductible plan, we will present you an estimate of today's charges based on the Medicare Fee Schedule.  In addition, we will inform you of the estimated patient responsibility amount that we will collect from you today at the completion of your visit.

At the completion of your visit, we will give you the estimated amount due based on the services provided for today's visit at check out.  Payment is expected at this time.

Should our estimate result in an underpayment for services rendered, you will receive a billing statement that will indicate any amounts not coered by your carrier.

Should our estimate result in an overpayment for services rendered, we will gladly refund the credit to you.  However, you do have the option of applying the overpayment to future services if you desire.

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, coinsurance 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 their annual Medicare B deductible.   Every Medicare B beneficiary must satisfy this deductible 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.