Billing and Insurance Policies
The best medical care can be provided only on the basis of mutual understanding. We encourage you to discuss any questions you may have regarding our policies with our billing staff.
We prefer that all patients pay at the time of their visit. Services covered by the primary insurance company will be billed to them. If you have a balance to pay, a statement will be mailed to you that is due within 30 days and before further non-emergent services are rendered. Charges and payments for services received during the last few days before your billing date may appear on a statement the following month.
Exam Fee and Refractions
During routine eye examinations medical problems are sometimes discovered. If a medical problem is found, we may in some cases be able to bill your primary medical insurance. It is mandatory that we divide the bill for your visit into a medical portion, which we can bill to your medical insurance, and refraction (eye glass prescription) portion. The refraction fee is $55.00. This is not covered by most major medical insurances. This fee will be collected at the time of your exam. Should your major medical insurance pay for the refraction, you will receive a refund. Contact lens fittings are not part of a routine exam. This is an extra service and there is a separate charge for this.
We require a photo ID for all patients and that you provide us with your current insurance card(s). The card should be readable. It should have the claim’s mailing address on it, and we will need your identification number for the policy. If you have a policy that restricts which providers you see, we encourage you to call your insurance company before seeing us. All co-payments are due at the time of the appointment. We will be happy to provide you with an itemized bill that you can submit for reimbursement from your secondary insurance.
Providing up to date information is required 7 days prior to services provided. This allows our office to pull authorization prior to appointments for eye care goods and services. Without this information, the patient is considered Self Pay at the time of the appointment.
We cannot tell you in advance if your particular insurance will cover your examination and treatment by our office. Insurance companies sell a variety of different plans to different employers. It is your responsibility to contact your insurance company or employer to determine your benefits. We will not accept responsibility for negotiating claims with insurance companies. You are responsible for payment of your medical care within a reasonable time, regardless of the status of a claim. Services not covered by your primary insurance are your responsibility.
When your insurance specifies a co-payment (indicated on the insurance identification card), this payment must be made at the time of your visit. We will collect the co-pay at the end of your visit along with any non-covered services. This way you will only need to pay once. (Note: Not all exams require a refraction, therefore we need to wait until you check out to see if you received this service.)
Prior Authorization, Referrals
Some health maintenance organization (HMO) plans require you to obtain a referral or prior-authorization for services from your primary care provider (internist, family practitioner, pediatrician, etc.). This is your responsibility. This is required by your insurance before you visit our office, even when the visit is for an urgent problem. If you have questions contact your insurer or the office of your primary care provider.
KIC and other IHS referrals
Anytime you are receiving services outside of KIC, to ensure that KICTHC will pay referral services, you will need a KIC Tribal Health Clinic referral form for each visit (unless otherwise indicated on the form). Referral slips must be picked up from the PRC (Purchased and Referred Care Services) prior to your appointment.
Our optical department requires a 50% deposit of the patient portion of charges prior to ordering glasses (and/or) contact lenses. Payment in full is expected at the time of delivery for all eyeglasses, contact lenses and supplies. Upon your request we will bill your insurance if coverage has been given to the clinic. It is your responsibility to contact your insurance to verify your allowed coverage of all frames, lenses, coatings etc. prior to having us order your glasses and also your responsibility to follow up with your insurance on the status of the claim. All insurances send an “Explanation of Benefits (EOB)” to their members when your claim is processed. If you have not received one within 3-4 weeks you should call your insurance company to see if there is a problem. If you do not understand or disagree with their determination and payment of your claim, you need to call your insurance company instead of the Ketchikan Eye Care. If your insurance company pays any patient collected amount, you will receive a refund.
We are participating providers under Medicare. Medicare only pays the contractual portion of the fees that they set, therefore if you have a secondary insurance registered with Medicare, the remaining balance will be billed automatically. The patient is responsible for any co-pays, deductibles and services not covered by Medicare’s allowed amount such as refractions (A refraction is the measurement of the eyeglass prescription). Medicare considers testing for eyeglass prescriptions to be routine vision care, not medical care, and therefore does not cover this service. This will be your responsibility after our billing department receives the Estimation of Benefits and sends out a statement.
The Ketchikan Eye Care Center and our Optical Department participate in the Medicaid programs for Alaska. Medicaid does not cover some refractive services such as contact lenses and contact lens fittings. We require Medicaid, DenaliCare, cards to be presented at every appointment. If you require a new card contact the State of Alaska Public Assistance Division at – 2030 Sea Level Dr, Ste 301, Ketchikan, AK · (907) 225-2135
REGARDING INSURANCE PLANS AND YOUR COVERAGE, be sure that you know your policy coverage and your primary carrier. For example: if the patient is the husband and retired and has Medicare, but the spouse is still working, her insurance is the Primary carrier, and Medicare would be husbands secondary. If you do not know the answer, contact your insurance company and they will supply you with the correct info.
Self-Pay (No Insurance)
If you do not have insurance coverage, we will require payment at the time of service.
THE COLLECTION PROCESS BEGINS ON ALL ACCOUNTS OVER 90 DAYS PAST DUE