MEDICAL INSURANCE INFORMATION
WILL YOUR MEDICAL INSURANCE COVER IT?
Dr. Johnson’s practice does not accept medical insurance for payment of services and he is considered an “out of network” provider. Dr. Johnson is not contracted with the insurance companies. We can not provide advice on how this treatment may or may not fit into your particular medical insurance plan. That said, you may still be able to get partially or fully reimbursed for the procedure. Generally, Dr. Johnson will provide patients with a detailed receipt which includes dates of service, diagnosis and treatment codes, and what has already been paid by the patient. The patient can submit a claim independently with this receipt. Your insurance web site or customer service representative should be able to help you get a claim form specific to your insurer. We have learned a few other things about this process and can share those observations mixed with some advice here.
COMMERCIAL INSURANCE INFORMATION (e.g. Blue Shield, United Healthcare, many others)
You could ask if the plan covers the laser treatment of vitreous degenerative disorders. The Pertinent codes are below:
CPT (Procedure Code): 67031 and performed 'in-office'
ICD-10 DIAGNOSIS codes we use:
H43.311 Vitreous Membranes/Strands- RIGHT EYE
H43.312 Vitreous Membranes/Strands- LEFT EYE
H43.313 Vitreous Membranes/Strands- BOTH EYES
If they ask, here are the medical practice's identifying numbers:
Federal ID number (EIN 26-4561133)
Corporation’s NPI number (1891018206)
MEDICARE RECIPIENT INFORMATION:
Dr. Johnson has opted out of the Medicare program. We have submitted an affidavit with the Medicare program attesting that we will not submit any claims to their program. As such, if you are over the age of 65 and a Medicare beneficiary, there are some special considerations that apply:
The patient will be entering into a private contract with Vitreous Floater Solutions, Inc.
Patient agrees not to submit a claim (or to request that Physician submit a claim) to the Medicare program with respect to the Services, even if covered by Medicare Part B.
Patient acknowledges that neither Medicare’s fee limitations nor any other Medicare reimbursement regulations apply to charges for the Services.
Patient acknowledges that Medi-Gap plans will not provide payment or reimbursement for the Services because payment is not made under the Medicare program, and other supplemental insurance plans may likewise deny reimbursement.