Understanding Your Insurance

Submited by Cindy P on December 6, 2017

Choosing Health Insurance: What you need to know.

Insurances can be tricky to understand, even for those who work with it every day. Insurance cards can be difficult to navigate and finding the information a patient needs to schedule correctly can be frustrating. With this guide, you’ll be an insurance pro in no time.

At LoBue Laser and Eye Medical Center, we use two types of insurance: medical and vision.

The type of insurance used depends on the type of exam the patient is having. It may seem like all examinations should fall under “vision” since our doctors are specialists in eye care, but in actuality vision and medical insurance cover specific exams.Refractive exams for glasses prescriptions, contact lens fittings, and the glasses or contacts themselves (called “material benefits”) would be covered by vision insurance.

Medical insurance would cover pressure checks, dilated exams for conditions such as diabetes or cataracts, and exams for patients who need to be seen because they are experiencing symptoms which may include redness, irritation, discharge, pain, and floaters.

There are several types of medical insurance, but the main ones include Medicare, HMO plans, and PPO plans. Medicare is familiar to most people as it is available to everyone over the age of 65 and some younger people with certain disabilities.

Medicare covers 80% of exam charges,

meaning a patient with Medicare will be responsible for the remaining 20% that the insurance does not cover. Medicare patients may also be responsible for a deductible at the time of their visit if theirs has not been met for the year. Fortunately, there are many supplements that patients may subscribe to in order to cover what Medicare doesn’t.

 

Many patients choose to sign up for a Part C Medicare Advantage Plan, effectively signing their benefits over to another insurance provider. These patients are still enrolled in Medicare, but their care is managed by the plan they signed up for, which often includes extra benefits. Many of these plans are partnered with vision plans as well, providing both services under one umbrella plan. If a patient is subscribed to one of these plans, such as AARP/United Healthcare, Scan, HealthNet, or one of many others, they should use the information from the plan ID card instead of their Medicare card since it is now their primary insurance. These may be HMO or PPO plans.

HMO stands for “health management organization”

Hmo works with closed networks of doctors, called medical groups or IPAs. Patients must get referrals from their primary care physician to see specialists, and they may see doctors within their medical group only.

 

LoBue Laser and Eye Medical Center is contracted with PrimeCare of Sun City and PrimeCare of Temecula, so patients within these medical groups will get referrals from their family doctors to  see us for their eye care needs. Not sure which medical group you’re in? Calling your primary care doctor is the fastest way to get this information.

What are the benefits of a PPO Insurance?

 

 

 

 

Some people prefer to subscribe to PPO plans to avoid being assigned to a primary care doctor and the necessity of referrals.With a PPO, patients can choose the doctors they would like to see, as long as the doctor is contracted with their insurance plan. PPO plans may have higher premiums and patients are frequently responsible for deductibles, however, and they must take care to choose doctors who are in network with their particular plan to avoid being billed for out of network provider costs.

 

 

 

 

LoBue Laser and Eye Medical Center accepts all in network PPO insurance plans. Unlike HMOs, PPO insurance plans are not often paired with vision insurance plans, so patients interested in vision benefits may choose to subscribe to a vision plan independently if that is not an option offered to them.

Call LoBue Laser and Eye Medical Centers, Inc. today to schedule an appointment. You may also speak with our appointment coordinators and make sure we accept an insurance before switching for re-enrollment .