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Understanding Dr. Winthrop's office policy regarding medical health insurance

In this ever-changing climate of health insurance, it can be frustrating to understand what kind of insurance you have, and if in fact, it will cover the office visits and procedures I provide.

I do NOT accept any HMO insurance plans. HMO plans have a panel of providers you must choose from to receive covered services. I am NOT a provider for any HMO plan and cannot bill for my services. If in fact, you prefer me to be your eye care provider, you are considered a “cash pay” patient, and payment is due at the time of service.

For Medicare patients, many carriers such as United Healthcare and Healthnet, for example, have plans that combine Medicare benefits and supplement insurance into one plan. Some of these plans are HMO’s, and it’s important to understand that if the plan is an HMO product I am NOT a provider. There are other plans like these that are NOT HMO plans, but PPO’s. If your card says PPO or Advantage Plan, I am a provider and can bill for services I provide you. Your co-pay and co-insurance (if any) are due at the time of service.

I am a provider for Medicare, but I am NOT AN ACCEPT ASSIGNMENT provider for Medicare. My office will bill Medicare and your supplement or secondary insurance for you and depending on which supplement or secondary insurance you have, we ask for payment at the time of service. Regardless, you will receive the payment for services, and if you already paid at the time of service, you keep the checks. If you didn’t pay at the time of service, we send you a bill showing the amount due, which will have been paid to you by Medicare and your supplement or secondary insurance.

For health insurance plans I am not a provider for, we ask for payment at the time of service and will bill your insurance company. In two to three weeks you will receive a check and explanation of benefits (EOB) showing how much was paid and applied to your deductible and co-insurance (if applicable).

I am a provider for Anthem Blue Cross, Blue Shield, Healthnet and Coresource. We will collect your co-pay and co-insurance (if we know the amount of your co-insurance) at the time of service. We then bill the insurance company and payment is sent directly to my office. 

I am not a  provider under Anthem Blue Cross Pathway PPO plans or Blue Shield PPO Affordable Care Act Plans.

I perform a refraction every time you have a full eye exam. The charge is $60.00 and is not covered by insurance. This fee is due at the time of service.

Please feel free to call our office any time if you have an insurance question. We are here to help in any way we can when it comes to this ever-changing world of insurance.

Office policy insurance billing form
Dr. Winthrop's Medicare billing policies and procedures download
Navigating your Flex Spending Account (FSA) for qualified medical expenses