Payment Options: Clayton Eye Center accepts cash, check and most major credit cards. Co-payment, deductibles and non-insurance items are due on the day of service. Insurance will be filed for covered services. Known non-covered services are due at the time of service. If your insurance declines payment, you will be responsible for paying the charges.
Financial Policies: Private Pay: It is our policy to collect in full on the day of service for all office visits, including same day surgical procedures.
Insurance: It is our policy to collect all patient co-payment amounts at the time services are provided. It is also our policy to bill for all non-paid amounts and to pursue collection efforts with regard to deductibles and underpayment. At the time of your appointment, the Check-In representative will verify your deductible and co-payment amounts, as well as ask if you intend to pay by check, cash or credit card. In the event a patient states he/she does not have the co-payment or deductible amount, the representative may offer to reschedule the patient for another day with the exception of a medical condition requiring immediate treatment. Medical necessity will be determined by the Clinic Manager, Manager on Duty, Doctor or a Clinic Technician.
Medicare: Clayton Eye Center “accepts assignment” from Medicare. This means that we accept what Medicare will pay and we will comply with all Medicare rules. Medicare rules require that we collect the deductible and 20% co-payment from the patient for all services including cataract surgery. Medicare rules require that we advise beneficiaries of possible non-covered services. See “Advance Beneficiary Notice”.
Medicare “Advance Beneficiary Notice (ABN)”: Clayton Eye Center provides the Medicare waiver or “Advance Beneficiary Notice” form. If you are given the ABN, please read carefully. Although Medicare may not pay for your items or services, there may be good reasons for your physician recommending them. Please allow us to assist by answering your questions. You should ask questions regarding your condition and why the tests are being requested by your provider. The ABN serves as proof that the beneficiary had knowledge prior to receiving a service or item that Medicare might not pay. www.hhs.gov
- What is an ABN? An ABN provides you the opportunity to accept or refuse certain items or services. An ABN is a written notice required by Medicare (government form OMB No. 0938-0566), given to you before you receive certain services or items, notifying you:
- that Medicare may deny payment
- the reason Medicare may deny payment
- and that you will be personally responsible for full payment if Mediare denies payment.
- Why does my physician or supplier routinely give me an ABN? Physicians and suppliers may routinely issue ABNs for services or items that are covered by Medicare, but that are only covered up to a certain number of times within a specified amount of time.
- Examples of “frequency limited” services include visual field testing, scanning laser tests, and photographs that Medicare will not pay if you exceed that limit on the service.
- If I receive an ABN, what are my options? You have the options to receive the service or to refuse them. In either case, you should choose on option on the form by checking the box provided, and then signing and dating it in the space provided.
- What if I refuse to sign the ABN but I want the service or item anyway? Your provider may decide not to provide the service or item to you. You may have a second person witness your refusal to sign the agreement and then receive the treatment. If the ABN is witnessed, you may be held responsible for payment because you are on notice of the likelihood of a Medicare denial. Your physician or supplier may not provide the service or item to you if you refuse the sign the ABN and agree to be responsible for payment.
- Who can help me if I have specific questions about what Medicare covers? The Medicare Helpline is 1-800-486-2048 or you may visit online at HHS.gov.
Collection Policies: It is our policy to collect all patient co-payment amounts at the time services are provided. It is also our policy to bill for all non-paid amounts and to pursue collection efforts with regard to deductibles and under-payment. Employees, who are charged with collecting amounts due to Clayton Eye Center, shall in all cases make a good faith effort to collect patient co-payments and deductibles. Except in the event of documented financial hardship, patient co-payments and deductibles shall not be waived.