Lumen Vision accepts most medical insurance plans for vision therapy services. Vision therapy is historically very difficult to get covered by insurance companies. Many insurance companies will cover codes for pre-testing, therapy, and post-testing, at least partially. For patients with high deductibles, these codes are often applied to the deductible. Insurance regulations require us to bill you for all charges allowed by your insurance. This includes deductibles, co-pays, and co-insurance amounts. If you choose to bill insurance, you will be responsible for all costs as assigned by your insurance carrier.

PRE-DETERMINATION OF BENEFITS

We will make contact with your insurance company prior to your orientation visit. We will do our best to get an estimate on what your out-of-pocket expenses will be. Please keep in mind, however, that insurance companies will not guarantee payment. Unfortunately, the only sure way to know if visits will be covered is to bill them and wait for the insurance claim to be reconciled.

Another way we can estimate coverage is to wait for pretesting to be reconciled. Two therapy codes are billed during pretesting. This is not a guarantee if they will cover it during the unit, but generally if they covered it during pretesting, they will cover at least some visits during the unit. If it was applied to deductible during pretesting, it will also go to deductible during the unit. Again, this is only an estimate of coverage. It also will not help with understanding coverage on visual information processing skills evaluations.

PAYMENT

We require all our patients to make payment for our therapy services in advance, or as outlined by their insurance company. Payment can be made in full, or set up on a payment plan at zero interest.

An insurance claim is not settled until receipt of the final EOB. You may still have a balance due at the end of therapy.

BILLING AND RECONCILIATION

We will bill your visits shortly after each visit. We will do our best to keep you updated as to the status of the claims, and let you know if insurance is reconciling the different from the original estimate. Ultimately, however, it is your responsibility to fully understand your insurance benefits and be aware of changes to them.

Copay: A fixed amount paid at the time of service. For example, if you have a $50 copay, you’d pay $50 for that visit.

Deductible: The amount you pay for covered health care services in a plan year before your health plan starts to contribute to your cost of care. With a $2,000 deductible, for example, you pay the first $2,000 of covered services.  

Coinsurance: The percentage of healthcare costs you're responsible for. After you meet the deductible, you and your insurance will share the cost of care until you've reached the out-of-pocket maximum. For example, if you have 20 percent coinsurance, your health plan would pay 80 percent of the bill and you would be responsible for the remaining 20 percent until your out-of-pocket maximum is reached. 

Out-Of-Pocket Maximum: When the amount you’ve spent on deductible and copay or coinsurance meets your out-of-pocket maximum amount, your health plan will pay for your eligible medical expenses for the rest of the plan year. This is the most you’ll have to pay out of pocket for your covered care.

WHAT DOES “COVERED” MEAN?

Your health plan offers payment for a service, although not necessarily at 100 percent. The cost is subject to copay, deductible, network, plan limits, and medical necessity.

WHAT DOES IT MEAN TO BE “MEDICALLY NECESSARY”?

Health care services, activities or supplies that are justified as reasonable, and/or appropriate, based on evidence-based clinical standards of care to treat an illness, injury, condition, disease or its symptoms. For example, vision therapy has been deemed medically necessary for diagnoses of convergence insufficiency and amblyopia by almost all medical insurance carriers.

WHAT DOES MY MEDICAL INSURANCE COVER?

Usually, your medical insurance pays for preventive care such as annual checkups, immunizations, screening for certain medical conditions and other services. Depending on your age and gender, most plans also cover practical health and wellness programs.

If you need medical care beyond the preventative services, you share costs with your insurance company. The sharing looks different depending on the plan you have, the specific service you receive, and how much healthcare you’ve used in a particular year.