At EYES.NYC, we are committed to providing exceptional eye care with clarity and honesty in our billing practices. Navigating insurance and billing can sometimes feel overwhelming, so we aim to make the process as seamless and transparent as possible.
Below, we discuss our insurance verification systems and address some of the most frequently asked questions and concerns about billing, including exam copays, denied claims, and contact lens exam and fitting copays.
Insurance Verification at EYES.NYC
To ensure a smooth experience, we require insurance information to be provided no later than 24 hours before your appointment. This allows us to verify your coverage for:
- Eye exam
- Contact lens exam and fitting
- Contact lenses allowance
- Eyewear allowance
Before your visit, we prepare a detailed insurance coverage breakdown so you know exactly what to expect. You will be notified of any out-of-pocket charges upon arrival. If your insurance is inactive or does not cover eye exams, we will notify you in advance to discuss your options. If you would like to discuss out-of-pocket expenses ahead of time, please do not hesitate to call us.
This thorough process helps us maintain high reimbursement rates and, most importantly, eliminates surprise billing for our patients.
Exam Copay
Exam copays are required at the time of service. A common question we receive is:
“Can I be billed for the copay?”
The answer is no. Here’s why:
- Small Practice Limitations
As a community-focused practice, we prioritize personalized care. We do not have the infrastructure to send separate invoices for copays, as this would increase administrative complexity and costs. - Keeping Costs Low
Collecting copays upfront helps us streamline operations and keep pricing affordable for all patients. Billing copays later often leads to additional expenses, which could impact our pricing and eventually be passed on to our customers. - Insurance Policies Require It
Most insurance plans mandate that copays are collected at the time of service. This aligns with the terms of your coverage and ensures financial responsibility is shared between you and your insurer.
Follow-Up Visit Copay: What You Need to Know
Sometimes, your annual eye exam may be divided into two visits:
- Initial Eye Exam
This visit includes your comprehensive eye exam, vision check, and overall eye health assessment. - Follow-Up Visit
This may include dilation and any necessary diagnostic testing.
Since this is essentially one appointment split into two, we do not charge a separate copay for the follow-up visit. This approach ensures you receive thorough care without additional financial burden.
We Do Not Bill Patients for Denied Claims
Another common concern is: “Will I be billed if my insurance denies the service?”
The answer is no. At EYES.NYC, we invest heavily in a thorough insurance verification process to minimize the risk of denied claims. If we identify issues with your coverage, we will notify you in advance and discuss your options. In the rare event that your insurance denies a claim for your eye exam, you will not be billed. Instead, we absorb the cost as part of our commitment to providing a stress-free experience for our patients.
Contact Lens Exams: What to Expect
A contact lens exam is separate from a regular eye exam. It involves additional testing to ensure your lenses fit properly and your prescription is accurate.
Insurance Coverage for Contact Lens Exams
Medical Insurance Plans (UHC, BCBS, Aetna, Cigna, etc.) do not cover contact lens exams and fitting.
Medicaid and Medicaid Vision Plans (Healthfirst, MetroPlus, Fidelis, etc.) do not cover contact lens exam and fitting.
Commercial Vision Plans (EyeMed, Spectera, VSP, Versant, etc.)
- Often include a separate copay for contact lens exams in addition to your regular exam copay.
- May cover contact lens exams and fittings for lenses within their formulary.
- Choosing lenses outside the formulary may result in additional out-of-pocket costs.
Given these limitations, getting a contact lens exam is likely to incur higher out-of-pocket expenses. If you are concerned about your out-of-pocket costs for a contact lens exam, please contact us before your appointment to clarify your expenses and explore your options.
Frequently Asked Questions
We strive to answer all your insurance-related questions. However, some matters are best clarified with your insurance provider or employer. Here are a few common questions:
1. Does my insurance cover eyewear once a year or once every two years?
Coverage varies by plan. Some policies cover eyewear annually, while others provide coverage once every two years.
2. Does my insurance provide coverage based on the date of service or calendar year?
Some plans reset benefits based on your last service date, while others follow the calendar year.
3. Does My Insurance Cover Replacement Eyeglasses?
The coverage for replacement eyeglasses depends on your specific insurance plan.
- Medicaid Plans: Some Medicaid plans, like MetroPlus Medicaid, may cover replacement eyeglasses. However, others, such as Healthfirst Medicaid, do not offer this coverage.
- Medicare Plans: Replacement coverage under Medicare varies. Medicare typically does not cover routine eyeglasses unless they are medically necessary, such as after cataract surgery. Certain supplemental plans may provide broader coverage for replacements.
- Employer-Sponsored Plans: These plans generally do not cover replacement eyeglasses, as coverage is often limited to one pair of glasses per benefit cycle.
For assistance verifying your insurance benefits or exploring replacement options, our team is happy to help!
At EYES.NYC, we’re committed to making your eye care experience as smooth and transparent as possible. If you have any questions about your coverage, don’t hesitate to reach out to us in advance.
Thank you for trusting EYES.NYC with your vision care needs!
