Insurance and Your Visit
Is my insurance accepted here?
We do accept most insurance plans including Medicare, BCBS, United Health Care Medical, DMBA, PEHP, Altius, Cigna, Select Med, Select Advantage Care, Aetna, Eyemed, VSP, and Davis to name a few. If you have Humana insurance you will need to have a referral from your primary care physician. If you do not see your insurance listed here please feel free to check with your insurance carrier to see if Dr. Daynes is on their panel.
Does my insurance cover a routine eye exam?
Most medical plans cover a routine eye exam once a year, but the patient is ultimately responsible for knowing if their insurance covers the eye exam. During your exam Dr. Daynes will check not only your vision, but the overall health of your eye. If a medical condition is found during the exam it will be billed accordingly and a routine eye exam may then be considered a medical exam. This will change how the insurance will process the claim, meaning co-pays, co-insurances, and deductibles may apply. Currently, some insurance companies are denying payment for Refraction (92015, the determination of the best glasses or contact lens prescription) as a non-covered service. Medicare does not cover the Refraction portion of the exam.
Will my contact lens evaluation be covered by insurance?
Most likely not. The reason most insurance companies do not cover a contact lens evaluation is because they consider it a cosmetic choice. If you have a medical condition of the eye which requires a specialized contact lens (keratoconus) your insurance carrier may pay for the fitting evaluation. However, it is your responsibility to find out if you have coverage on medically necessary contact lenses.
Does my insurance cover retinal photos or visual fields?
We have found that most major medical insurances do cover the retinal photos and visual fields, but it may also be subject to deductibles. We will usually try to submit them and then send in the photos from year to year.
If I don’t have insurance or choose not to bill my insurance can I still get an eye exam?
Yes! We offer a significant discount for the exam when you pay on the day you are seen. Please call our office at (801) 294-8855 for more information on the special pricing.
What if I can’t find my insurance card at my appointment?
If at your appointment you are not able to find your insurance card we ask that as soon as you do find it you give our office a call with your information. If we do not receive your insurance information within or the next business day we will assume you will be personally responsible for charges incurred during the appointment. For state funded insurances we must have your monthly card presented at the time of service.
Why did my routine eye exam have a co-pay?
The co-pay is subject to your insurance plan. If you have a medical condition like glaucoma or diabetes you can expect to have a co-pay. If you have had a surgical procedure (outside of Lasik) you will not be subject to co-pays for post operative care during the first ninety days following surgery.
Why was my claim denied by my insurance?
Claims may be denied for many reasons:
Incorrect date of birth
The insurance company could think the patient may have other insurance and request information from the patient
They could only have one routine eye exam a year and we have seen them twice in a year
We could have been given the wrong identification numbers
If your claim has been denied your insurance company will be able to give you the best information regarding the denial. It is the patient’s responsibility to provide our office with the most current insurance information available, including secondary coverage or materials coverage.
When should I expect to hear if I owe something?
We do our best to bill insurance companies in a timely manner. Ultimately it depends on when we hear from the insurance company. It could take one week or up to two months. Also, if there is a second insurance it may take longer.
Will my insurance cover an emergency visit to your office?
We never know for sure what individual policies will cover, but we do submit to all the major insurance companies. Most visits will be handled according to their deductible and co-pays. Again, we don’t know what those are and the patient would be responsible to check on this.