Know Your Insurance
At In Focus Eyecare, our goal is to promote good eye health and enable you to have the clearest vision possible. We accept several types of vision and medical insurances, cash, checks, and most credit/debit/FSA/HSA cards. Payment arrangements may be set up with the office manager on a case by case basis. Due to all the changes in the insurance industry with the institution of the Affordable Care Act, it is very important that you contact your insurance company to make sure that Andrea P. Neff, O.D. and/or In Focus Eyecare are considered in-network by your insurance to avoid the unexpected surprise of YOU being responsible for all of the cost of your visit. In Focus Eyecare cannot guarantee coverage of any procedure by your insurance. Even when we verify coverage with in-network insurance before services, coverage is determined by the insurance company as they process the claim. If your insurance does not consider us in-network you will be responsible for a large portion or all of the cost of your visit. Believe the disclaimer given by the insurance companies when calling for benefits that states, "This is NOT a guarantee of benefits. Benefits will be determined at the time the claim is processed." If you require a breakdown of costs, please let us know. Some insurance companies do a better job of educating their clients than others. At times insurance companies' "Customer Service" departments overstate benefits (and minimize or even ignore specific limits and restrictions) that can create an adversarial relationship between the patient and the doctor's office. We would like to avoid these misconceptions. We hope that the following section will help you better understand how vision coverage works.
As a courtesy to our patients, we are happy to file your insurance claims for you for any insurance company with which we are contracted and therefore are considered in-network. If you would like us to file your in-network claims for you, we need your insurance information (name of insurance, member id#, name of primary, date of birth of primary) at least one business day before your appointment. We are not able to verify coverage and obtain authorizations if we do not have your information until the day of your appointment. Not able to get us the information before your appointment? No worries, you can pay out of pocket and we will provide you with an itemized and coded invoice at checkout that will allow you to submit a claim to your insurance for your reimbursement.
Dr. Neff is considered a specialist. If you are covered under an HMO, you must first obtain a referral to us from your Primary Care Physician (PCP) before your HMO will cover your visit!
Vision and Medical Insurance
Let's face it, insurance can be confusing. The knowledgeable staff at In Focus Eyecare is experienced in working with vision and medical insurance providers. When we are provided with insurance information in advance of your appointment, we will work directly with you and your insurer to obtain authorization for service and then submit claims regarding your eye care to contracted insurances companies. We strive to ensure that you understand your insurance coverage and will do our best to answer any questions you may have regarding your benefits. Many current vision plans are designed to cover most of the basic vision-related costs, but not all costs associated with eye care. Most plans require a co-payment for an office appointment as well as additional costs that are covered by the insured patient. Many people with medical insurance have a separate vision insurance rider policy to cover routine exams.
Differences between Vision and Medical Insurances
• Vision insurance typically covers a basic eye health assessment and prescription for glasses annually. Many plans help to pay for contact lens fitting and contact lenses or glasses. Co-pays and amounts of coverage vary greatly from plan to plan. This kind of plan does not cover assessment, testing, and care for medical conditions. Regardless of your vision insurance, most plans do not cover 100% of expenses, thus you should expect some out-of-pocket costs. All co-pays are due at the time services are rendered per your contract with your insurance AND our contract with your insurance. At least half of the patient's cost of any materials ordered (glasses or contacts) must be paid before these items can be ordered.
• Medical insurance coverage should be used when the doctor is assessing a medical condition that can affect your eyes such as diabetes, hypertension, glaucoma, macular degeneration, use of high risk medication, etc. It is also used when you have a medical eye problem or emergency like cataracts, dry eyes, allergies, or infection. Medical co-pays and deductibles apply in these cases. A few medical insurance plans will cover annual vision exams and possibly materials. In Focus Eyecare will not submit claims for materials to medical insurance. Medical concerns take priority and as such will be treated first or concurrently with vision problems. Sometimes a medical condition needs to be treated and corrected before vision can be accurately evaluated. You are responsible for the cost of the refraction if your insurance is medical only.
The rules and procedures for how and when to use your insurance are created by your insurance company. Dr. Neff provides the care necessary based on your vision and eye health needs. There is no way to know before an exam whether a patient's blurry vision is due to simply to a need for glasses or if it's caused by a medical condition like cataracts or dry eyes.
Although our staff members are very knowledgeable about insurance plans, remember that it is not the doctor's or staff's responsibility to know all the details of your individual plan. Your insurance is a contract between you, your employer and the insurance company, not with the doctor. If you have questions regarding how your specific plan details will apply to your upcoming visit, we will do everything we can to help you better understand it.
Insurance accepted by In Focus Eyecare and IFE Optical
Vision Plans we accept:
VSP-Vision Service Plan (we are not in-network with VSP Elements)
Medical Insurance we accept:
United Health Care
Blue Cross Blue Shield (we are not in-network with all plans i.e. SC BlueChoice, SC Blue Essentials, SC Blue Option or SC MyChoice, Healthy Connections, EPOs)
Aetna (we are not in-network but some Medicare Advantage plans pay the same in or out of network)
Cigna (we are not considered in-network with all plans)
SC Medicaid (we are not in-network with SC Medicaid MCO's)
We are not able be a contracted Tricare Network Provider due to being too far from a military facility but we are a Tricare Participating Provider and are proud to submit claims to Tricare for our active military and veterans.
If the Medical Insurance you carry contracts with a vision plan, it is best to call your insurance to find out what the name of the vision plan is. Be aware that they may rebrand a common vision insurance with which we are contracted to a name of which we are unfamiliar.
Please call your insurance to make sure we are a contracted provider with them. Insurance is constantly changing with the institution of the Affordable Care Act!
We are NOT IN-NETWORK or contracted with... EyeMed, Davis Vision, Spectera, United Healthcare Vision, Optum Vision, Superior Vision, VSP Elements, Avesis, Aetna, Care Improvement Plus, Absolute Total Care, SC Medicaid Managed Care Options (MCOs), SC BlueChoice, SC Blue Essentials, SC Blue Option, SC MyChoice, VSP Elements, BCBS EPOs, and many new plans developed as a result of ObamaCare which require individual contracts. We may still show up as in-network on their provider lists due to several reasons including failure to update their lists and being in-network with their medical plan but not their vision plan.
Flexible Spending Accounts
Many employers are offering Flexible Spending Account (FSA) options to employees. Sometimes these are referred to as cafeteria plans and are elective, supplemental insurance savings plans. These plans are designed to let you save money in an account, pre-tax, to pay for additional medical expenses such as eye exams, glasses, contacts, and often laser vision surgery. Check with the benefits administrator at your work to see if you are eligible for this program. FSAs can typically be used in conjunction with any vision insurance plan to offset any out-of-pocket costs on your behalf.
Other Payment Options
Our Fort Mill optometry staff understands that cost is a concern when evaluating vision care providers. We do not want cost to be an obstacle to maintaining proper eye health and good vision. We accept various forms of payment and are able to discuss financing options with you prior to any examination. At In Focus Eyecare, we also accept cash, check, and major credit cards. Call 803-802-6522 today to schedule your eye exam today.