Insurance

The physicians of the Brumm Eye Center participate with Medicare and most insurance companies. Most insurance companies have different benefit levels depending on whether or not the patient sees a physician, who participates with their company, therefore you should check with your insurance company for a list of participating providers and facilities. It is important that you provide us with complete and accurate information on your insurance coverage. You should also notify us immediately if you have changed your insurance carrier.

Non-Participating Insurance Plans

If we do not have a contractual agreement with your insurance company, you are financially responsible for payment in full for all services provided at the time of service. You will be given a charge slip that contains detailed information that the insurance company will need for you to file the claim yourself.

Co-Payments

If your insurance plan requires a co-payment for an office visit, that amount is due at check-in before you see the doctor.

Health Maintenance Organization (HMO)

If you are a participant in a Health Maintenance Organization (HMO), it is your responsibility to know if your plan requires a referral for you to see a specialist. If a referral is required, it must be obtained prior to your visit. If you are unable to obtain a referral, you may not be able to be seen by our physicians.

Medicare

Brumm Eye Center physicians participate with Medicare. This means that the patient is charged the amount that Medicare allows. This does not mean that Medicare patients will never have to pay for services. It is likely that patients will have a balance after the Medicare payment.

Deductibles & Co-payments

The deductible is the amount a person must pay toward medical bills in a calendar year before Medicare benefits are provided. The deductible for physician services is $100. After the deductible is met, Medicare pays 80% of the allowed fee for all covered medical expenses incurred during the year. The remaining 20% is the co-insurance; this is the amount billed to the patient or the patient’s secondary or supplemental insurance.

Filing Procedures

Brumm Eye Center will electronically file claims for covered office services. Once we have received the explanation of benefits (EOB) from Medicare with either their 80% payment or their denial of benefits, we will then forward the remaining 20% to the secondary or supplemental insurance company.

Services Not Covered

Medicare does not cover all services such as routine examinations where no medical diagnosis in involved. It also does not cover the cost of a refraction (that part of the eye exam that determines the power of a patient’s prescription for eyeglasses). The patient will be expected to pay for these charges at the time of service. Brumm Eye Center will bill Medicare for covered surgical services. After Medicare has responded, a claim will be forwarded to the secondary or supplemental insurance company.