Billing and Insurance — Updated 6/15/2016
At Pacific EyeCare, we recognize the importance of our patients knowing and understanding the issues that affect the total cost and out-of-pocket cost of care they receive. We have developed the following written policies to ensure that all of our patients understand the services our Billing Department provides and the rights and responsibilities our patients have with regard to payment for services.
Insurance Benefits, Covered Services, and Eligibility
Pacific EyeCare is contracted as a participating provider or preferred provider with a number of health insurance plans. Many of these plans offer more than one insurance product, often with specific limitations. It is the responsibility of the patient to know his or her insurance coverage. As a patient you are specifically responsible for:
• Verifying that Pacific EyeCare is a contracted
provider for your specific insurance plan
• Obtaining a referral if necessary prior to seeing the doctor
• Determining that you are eligible at the time of service
• Knowing what services (benefits) are covered and
what services are not covered by your insurance plan
• Knowing if authorization is required in advance of surgery
• Payment of all co-payments, co-insurance, and deductibles.
If you have not already done so, please familiarize yourself with your insurance benefits and cost sharing agreement. If after contacting your insurance plan you still have questions, our Billing Department will gladly work with you and a representative of your plan to resolve your questions. We will need you to provide us with the information on your insurance card.
Insurance Plans — Preferred Provider (contracted)
Pacific EyeCare will bill your insurance company as a courtesy to you. It is your responsibility to know what your coverage is and which providers are covered under your plan. The best way to determine coverage is by calling the phone number listed on your insurance card. We believe that the better understanding you have regarding your insurance coverage, the better we can serve you.
The following is a list of the major insurance plans and Pacific EyeCare’s relationship with these carriers. This is not a complete list, and is subject to change without notice.
• Aetna
• CHAMPVA
• Department of Social & Health Services (Washington Medicaid)
• First Choice
• First Health/Coventry
• GEHA
• Kaiser Permanente (usually requires a referral)
• Humana
• Medicare Part B
• Multi Plan
• NW Benefits (NBN)
• Premera
• Railroad Medicare
• Regence Blue Shield
• Sterling Option Plans
• United Healthcare
• Veterans Administration (VA) (referral required)
• Vision Service Plan (VSP)
• Washington Labor & Industries
• Labor and Industries
• Lifewise Health Plan
Other Accepted Plans (Non-preferred provider, Non-contracted)
• Cigna (PEC will courtesy bill on your behalf)
• TriCare Standard
• TriCare for Life
• Veterans Choice (With Referral Only)
• TriCare Prime (With Referral Only)
Not Accepted:
• Amerigroup
• Coordinated Care
• Molina Healthcare
• Superior Vision
• TriCare Prime (without referral)
Insurance Billing and Statement of Account
If Pacific EyeCare is contracted with your insurance plan, you will receive a statement of account by mail indicating any balance due after we have billed your insurance plan and it has processed your claim. Our charges will be listed on the statement along with any payments made by your insurance plan and contractual discounts required by our contract. This statement should also correspond to the Explanation of Benefits (EOB) you receive in the mail from your insurance plan. You will receive an individual statement of account on a monthly basis. Payment is due upon receipt.
Payment and Credit Arrangements
If you are age 18 or older, you are legally responsible for the charges you incur regardless of who you live with or the Guarantor of your Insurance Plan. Parents are financially responsible for the charges incurred by their children under the age of 18.
If you do not have insurance, or if your insurance coverage is with a plan that Pacific EyeCare does not contract with you will be asked to pay the amount due in full at the time of your appointment. Additionally, purchases made in one of our optical shops must be paid for in full at the time of delivery of any merchandise. The Billing Department is available to assist with an estimate of your charges, but an exact amount may not be known until the services are provided.
Co-Payments are due at the time of service. Co-insurance will be due at the time of service for all elective surgery. Our contracts obligate us to collect all co-payments, deductibles, and co-insurance from you. Please do not ask us to write-off these amounts from your account or accept additional discounts.
Online Payments
You may pay online by clicking here.
Billing Inquiries
At Pacific EyeCare, the Billing Department handles all charges, insurance billing, and payment arrangements. If you have questions regarding our policies, or your statement of account, please call our Billing Department at: (360) 626-5218.