We know that health insurance and health care costs can be confusing.
Here are some resources : explanations of insurance, transparent pricing information, and bill pay links
Vision Insurance vs Medical Insurance
A vision insurance policy is different from your health insurance policy. Regular medical health insurance protects you from unexpected costs for eye injury or disease. In contrast, vision insurance provides an added wellness benefit for healthy eye exams, which includes routine eye care, prescription eyewear and contact lenses, and other vision services at a reduced cost. Some examples of vision insurance include Spectera, Eyemed, and VSP. A good way to think about it is that vision insurance covers your optical needs while medical insurance covers eye diseases or medical conditions that can cause problems with your eyes.
Vision plans do not cover any part of an eye exam considered “medical”. For example, vision insurance will not cover vision loss, floaters, dry eyes, allergies, infections, eye disease, or eye exams for complication from diabetes. If you need medication the doctor will not be able to give you a prescription if you are using a vision insurance. Additionally, some vision insurance plans do not cover contact lens fittings (for first time wearers or established wearers that need to switch to a new brand) or yearly contact lens evaluations.
Financing
There are some surgeries, optical items, and services that are not covered by a patients’ insurance. We understand that some patients may prefer to pay for these items and services in installments. Because of this we participate in Care Credit, which is a medical financing service. There are also situations where you may have a large deductible and need help breaking up your payment into installments. Please let us know if you would like more information or would like to apply for credit when you are in our office.
What are our cash charges
We try to be fair in our cash based pricing. We only charge you what we expect to be paid by insurance, not an inflated charge master cost. In this way we hope that patients who do not have insurance are not subjected to unrealistic charges that we are not typically reimbursed by insurance. We feel this is fair to our practice and to patients.
Cash cost for clinic visits
We follow the Medicare reimbursement fee schedule.
Usually this means that if you are in our office for a cash visit you will have a bill between $80 to $170 not including testing
Testing charges can add approximately $50 or more to your visit.
Cash cost for surgery
We follow the Medicare reimbursement fee schedule, for most of our surgeries
For standard cataract surgery with a standard lens the surgeon fee is $650
Cost of elective IOL upgrades at the time of cataract surgery
For all elective implants the cost is typically split as payment to the surgery center and to our practice.
The prices below are the TOTAL cost of the payment to us and the surgery center
Please keep in mind that the price below DOES NOT include the cost of any corneal refractive surgery enhancements, if needed to fine tune vision. Some practices have higher base prices and bundle any refractive surgery enhancements. Fortunately, the chance for error is relatively low, and instead of pricing every surgery higher, we charge a fair price, and patients who need enhancements will have to pay for that extra cost individually.
Toric lens implants: $1500
Multifocal lens implants: $2500
Light Adjustable lens: $1950 (includes 2 lock in treatments). Each treatment to adjust the lens power is $750 (up to three)
“Why do I have 3 different bills when I have surgery”—Understanding Your Outpatient Surgery Charges
For most outpatient surgeries, it is normal to receive separate bills from different providers involved in your care. This does not mean you were charged multiple times for the same service. Each bill reflects a distinct part of your procedure.
There are typically three types of charges:
Anesthesia Fee
This covers the services of the anesthesia professional who ensures your comfort and safety before, during, and immediately after surgery. Anesthesia services are billed separately because they are provided by a specialized medical team.Facility Fee
This fee comes from the surgery center or hospital where your procedure takes place. It covers the use of the operating room, medical equipment, nursing staff, medications, and supplies required to safely perform your surgery.Professional (Surgeon) Fee
This is the charge from the surgeon who performed your procedure. It reflects the medical expertise, time, and care involved in planning and completing your surgery, as well as post-operative follow-up.
Insurance coverage and patient responsibility can vary for each of these charges depending on your specific plan. If you have questions about billing or coverage, our team is happy to help guide you.
Common reasons patients have a payment balance
Patients may owe a balance for medical care even when they have health insurance. This is common and usually related to how insurance plans share costs between the insurer and the patient. Patient payments are most often the result of deductibles, copays, coinsurance, and network rules, rather than billing errors. Insurance is designed to share costs—not eliminate them—and patient responsibility varies based on plan design, timing within the year, and where care is received. We hope that understanding these factors helps set clear expectations and reduces confusion and frustration about medical bills. Below are the most common reasons a patient may be responsible for payment.
1. Deductible
A deductible is the amount a patient must pay out of pocket each year before their insurance begins to cover services. This is a form of cost-sharing with patients and their insurance plans.
If the deductible has not been met, the patient is responsible for the full or partial cost of the visit.
Unfortunately, many affordable health insurance plans may have higher deductible limits
2. Copayment (Copay)
A copay is a fixed dollar amount the patient pays for a visit or service.
Common examples include a $10 to $100 for specialist visits
Copays apply even after the deductible is met.
3. Coinsurance
Coinsurance is a percentage of the allowed charge that the patient pays after meeting their deductible.
A common split is 80% paid by insurance and 20% paid by the patient.
Higher-cost services can result in larger coinsurance balances.
4. Out-of-Network Coverage
If a provider or facility is out of the patient’s insurance network:
Insurance may pay a smaller portion or nothing at all.
The patient may be billed the difference between the provider’s charge and the insurance’s allowed amount
Sometimes more affordable plans have “narrow” networks, which restrict access to many specialists.
We will try to inform you if you are not in network before your appointment
5. Non-Covered or Denied Services
Insurance may deny payment for certain services.
Reasons include lack of medical necessity, missing authorization, or benefit exclusions.
The patient may be responsible for the full charge.
If you have an HMO plan you may need to have authorization (an authorization #) before you can see a specialist or else your visit will not be covered.
6. Cash Pay / Self-Pay
Patients without active insurance or who choose not to use their insurance may pay directly.
This may occur if insurance is inactive, not accepted, or the patient prefers self-pay rates.
This could be because a patient does not have insurance, or they want to go outside their network to pay cash for service
7. Annual Out-of-Pocket Maximum Not Met
Until a patient reaches their annual out-of-pocket maximum:
Deductibles, copays, and coinsurance continue to apply.
Once met, insurance typically covers eligible services at 100%.
8. Coverage Timing Issues
Insurance may not have been active on the date of service.
Delayed enrollment updates or incorrect information can shift costs to the patient.