Payment and Insurance.

East Valley Ophthalmology offers many payment options. We are pleased to discuss our fees with you before we provide any services.

Vision Care Financing.

In addition to cash, personal checks, and most major credit cards, East Valley Ophthalmology makes world-class vision care available through independent financing from CareCredit and Capital One Healthcare Finance. If you'd like assistance with your application, your questions answered, or to make an appointment, please call: 480-981-6111

Capital One Healthcare Finance

Capital One Healthcare Finance provides predictable payment plans with the convenience of a credit card. Unlike most credit cards, Capital One Healthcare Finance allows you to customize your loan by selecting the amount you need and your repayment terms — from three months to five years. Use Capital One Healthcare Finance to pay for elective procedures, from $995 to $25,000.

CareCredit

CareCredit works just like a credit card, but is exclusively for healthcare services. It's better than most credit cards because you get no-interest financing or low monthly payments every time you use it. Plus, you can use your card over and over for elective procedures and follow-up appointments.

Flexible Spending Account (FSA)

Find out if your employer health care plan includes a Flexible Spending Account, also called a Flex Plan or Reimbursement Account. Contributions to these plans are made through automatic and regular deductions from your paychecks. This employer sponsored benefit allows you to pay for eligible medical expenses on a pre-tax basis. Since the funds placed in the account are not taxed, they go much further in covering eligible medical expenses. For more information, go to: FSAFEDS

What Is Covered?

The eye care services that are covered by your insurance company are not determined by our office. Rather, they are determined by a contractual agreement between the insurance company and your employer.

Each insurance company has multiple plans that cover different services. It is completely your obligation to know the benefits and limitations of your own insurance plan. Some plans require referrals, some require that you use only doctors on a list. You must be familiar with what your coverage is and the necessary fulfillment requirements before making your appointment.

If you have the typical medical plan (indemnity, HMO, PPO, IPO), you should know that most eye care programs specifically "exclude refraction" and contact lens related examinations. This means that the determination of your eye glass and contact lens prescription are not a covered service. If you elect to have our office evaluate the fit of your contract lenses and/or change your prescriptions, there will be an out-of-pocket fee involved.

Acceptance Of Insurance.

Your insurance will be accepted strictly according to the benefits of your policy. The necessary information must be obtained during your pre-registration call, so please have the information handy. If you do not have insurance, you will need to make other arrangements in advance or your appointment will be postponed or cancelled.

If your insurance requires you to pre-certify, pre-authorize or get a second opinion, you must do this prior to your eye surgery date or your surgery will be postponed or cancelled.

If you would like further information, please call our office at:

480-981-6111

Accepted Insurance Plans:

We would be delighted to file for your insurance and Medicare claims as long as you provide us with complete and accurate information. It is necessary to keep in mind that we work for you, not your insurance company, which means that you are ultimately responsible for all payments. Any charges not covered by your insurance, are due and payable at the time of service, unless other arrangements have been made before your scheduled appointment. If you are not on one of these insurance plans, you may still see us "out of network." Plans that Dr. Nirenberg and Dr. Kao accept include:

• AHCCCS
• AMN
• Arizona Industrial Commission
• Arizona Foundation for Medical Care
• Banner Choice Plus
• Beech Street/CAPP Care PPO
• Blue Cross Blue Shield
• Coventry Healthcare/First Health/CCN PPO
• Healthnet of Arizona PPO
• Mayo PPO through Arizona Foundation
• Medicare
• Medicare replacements (fee for service only)
• Multiplan
• Private Healthcare Systems (PHCS)

In addition, Dr. Kao also accepts Aetna. As of May, 1, 2008, United Healthcare will be added to this list for both Dr. Nirenberg and Dr. Kao.

Dr. Hill's Specialized Services:

There are perhaps five ophthalmologists in the entire U.S. offering the kind of IOL power calculation services that Dr. Hill does, and no other in our region. As Dr. Hill is a Medicare provider, our office will submit a claim for those services covered by Medicare, but for any non-covered Medicare services, it is customary for payment to be made on the day of your visit.

For other heath plans, a visit with Dr. Hill will likely be considered "out of network" and may also require prior authorization if you are to be reimbursed by your insurance carrier. We wil provide you with the necessary insurance forms to send to your health plan, but it is customary for payment to be made on the day of your visit.

Gap Insurance:

Because Dr. Hill's expertise is highly specialized, a patient receiving his services may qualify for GAP insurance and/or out of network benefits. When a patient does not have out-of-network benefits, he or she may still be eligible for GAP insurance due to Dr. Hill's "specialized services" for IOL power calculations.

For IOL power calculations, there are five separate insurance codes used to arrive at the final reimbursement. Under normal circumstances, these codes are all that may be required by an ophthalmologist to receive insurance reimbursement. However, the "specialized services" interpretation cannot be performed by most ophthalmologists, as this requires a particular expertise and a different reimbursement rate.

In order for a patient to receive GAP insurance benefits, he or she must obtain prior authorization for these specialized services. In this case, the expertise of a Certified Procedural Coder (CPC) would be required to work with the utilization review staff of your insurance company.

East Valley Ophthalmology has two staff member that are Certified Procedural Coders (CPC) and are readily available to assist you on an individual basis. Please ask for either Patti Lowrance, MHA, COE, CPC, CCP or Samantha Collins, CPC,CCP, RMC and they will be happy to help. They may be reached at:

480-981-6111

The Best Possible Eye Care

The eye surgeons of East Valley Ophthalmology perform the full scope of advanced technology diagnostic testing and treatment, as well as taking the time necessary to provide each patient the personal education needed to fully understand their condition and get the best possible outcomes for their patients. If you or a family member or friend have not had a recent eye examination, please take a moment to Request an Appointment.