Vision Plans/Insurance/Coverage Flashcards
are non-medical, non-emergency and are scheduled as a “check-up,” not as a necessity. These are visits that fall under vision care plans.
Routine visits
A ‘ ‘ eye exam should include examination of the eye internally and externally, and include refraction. Refraction determines the patient’s prescription, the old, “Which is better one or two,” thing?
Routine eye exam
are a necessity or emergency. The patient is suffering from some discomfort with their physical eye or vision and feels the need to address the problem immediately. Medical conditions that require monitoring, like glaucoma, diabetes or macular degeneration are also covered by medical plans.
Medical Exams
Reconciling the statement: You are looking for the amounts to be neither under nor over what is expected.
Insurance claims are matched to an EOB or an Explanation Of Benefits. This statement is sent to the patient or customer so they can compare what they paid with what the insurance company states that they should have paid. It is also sent to the provider and is used to compare what you think you should have been paid and what the insurance company actually sent you. Comparing the two
What is Medicare?
Medicare is insurance for people who are 65 and older, people with or without certain disabilities, or medical conditions. Medicare does not pay the refraction fee portion of the exam. It will be up to the individual practice or store if you accept Medicare. Medicare is nothing to take lightly! Do not attempt to file claims for Medicare if you do not know what you are doing. Keep accurate records in case of an audit.
What is COBRA?
COBRA means Consolidated Omnibus Budget Reconciliation Act and it is a way to continue your insurance coverage if your employment should terminate. What does it mean to you? Nothing! It is just a term that you will hear used so you should know what it means. Your patient either has coverage or they do not and you can get an authorization or you cannot. This is an area where there can be errors in enrollment. If a customer feels their have chosen COBRA benefits for vision or medical, but you’re unable to find anything and the insurance company is unable to find anything, the customer needs to speak with their HR department.
What is Medicaid?
Medicaid is a health and medical services program for individuals and families with low income and few resources.
What is a flexible spending account or FSA?
A Flexible Spending Account (FSA) or Health Savings Account (HSA) are employer-sponsored benefits that enable the insured to pay for eligible medical expenses on a pre-tax basis. They get to set aside a pre-determined amount for the year and use that amount towards their medical expenses. Since the amount is tax sheltered, the use of the funds are closely regulated. FSA accounts must be used within a set time limit or they are forfeited. This can work in your favor when a patient has three or four days to use up hundreds or even thousands of dollars, or lose them.
