Fees and Insurance

The physicians at Pediatric Ophthalmology and Strabismus Surgical Associates have always made every effort to provide the highest quality care at reasonable cost. In an effort to continue to keep the cost of eye care at a reasonable level, we have the following policies:

Self-Payment

If you are the person responsible for payment for your visit or your child's visit, we ask that you pay in full at the time the service is delivered. This will reduce the cost of preparing, processing, and mailing statements at the end of the month and permit the staff of this office to concentrate on providing the best possible eye care for your family.

Patient Balance & Insurance Claims

You are ultimately responsible for payment for the care provided to you by this office. We will assist you in filing for coverage for your office visit if you have coverage for eye care. If eye care visits are covered by a third party insurance company or an HMO, you should be aware of the reimbursement policies of your insurance carrier. There have been increasing numbers of insurance programs and prepaid methods to cover eye care and health care in general and this has created an increased amount of complex paperwork to process each patient's claim. Each care plan has separate rules for authorization, payment, and handling of claims.

You should be familiar with the extent and type of coverage for your family and carry appropriate identification cards to enable you to receive all of the benefits that are available to your family. It is your responsibility to bring all necessary referral forms, current insurance cards, authorizations and patient's social security number with you for each visit to our office. Medical examinations cover medical and surgical problems. Many plans require preauthorization for coverage.

Only some health plans cover office visits for vision care. The extent of coverage is determined by the insurance company policy that you have purchased. Each company will have several different coverage plans. To avoid misunderstanding, you should become familiar with the eye care benefits you are covered for and have appropriate authorization forms available at the time of your visit. If there is doubt regarding coverage, please pay for your office visit and submit appropriate forms to your company for reimbursement. All balances are to be paid in 60 days. Patients may also be refracted during your office visit. This service is not included in the new evaluation and management codes that have been used since January 1998. Refractions are a non-covered service by Medicare guidelines.

Your understanding and cooperation in these matters is appreciated by all of our staff. Questions regarding billing should be addressed to the billing department at 724-772-3388, Monday thru Thursday, 9:00 am to 3:00 pm.