Office and Financial Policies

Texas Retina Associates accepts many insurance plans. Our experienced billing and insurance specialists can answer your questions regarding insurance coverage and assist you with referrals. If you have a co-pay or deductible not covered by your insurance, we will collect that from you at your visit. At your first appointment, our staff will also work with you to go over our financial policy. For your convenience, we accept credit cards and your debit card as well as cash or a check. Our fees vary with the complexity of the examination or treatment and can be provided upon request. Special billing policies apply to the following patients:

  • MEDICARE – We accept assignment on Part B Medicare patients. You will be expected to pay your deductible and a 20% co-payment.
  • SECONDARY INSURANCE – If you have secondary insurance coverage that we are able to verify with your insurance carrier, we will be happy to file on your behalf. If we are unable to collect directly from the carrier within 45 days, you will be responsible for payment at that time.
  • MEDICAID – If your coverage is active, we will file your claim.
  • HMO/PPO/MANAGED CARE – Our physicians have agreed to be specialty providers for many of the HMO/PPO plans. It is important for you to consult with billing personnel prior to your visit. They will work with you to verify your coverage amounts and let you know your payment responsibility. They will also collect any payment at the time of your visit.  Click here for a list of the insurance plans we accept.

Referrals

If you belong to a pre-paid plan, HMO, or point-of-service contract, please consult the referral rules in your health plan. You will need to provide us with the referral number which you can obtain from your primary care physician (PCP) prior to your visit. Even if another eye doctor refers you to our office, a referral number from your PCP is often required. If you have an established PCP, you may be able to handle this by telephone.  For urgent and emergency eye problems, our office staff will try to help you if you have no PCP. However, you may not be able to obtain a referral number without being seen by a plan PCP. In this situation, you will be responsible for payment of services. Your health plan has the final word on authorization of referral services.

Co-payments

Most pre-paid health plans require you to make a co-payment with each visit. These cannot be billed to you so please be prepared to make this payment when you check in at our office.

Surgical procedures

Our office will be glad to process your insurance claim for surgical procedures. Prior to your surgery, we will pre-approve the procedure with your health plan and determine any payments for which you may be responsible. We will collect the patient responsibility portion for your surgery prior to scheduling the procedure. Please be sure that we have your correct insurance information. If your carrier requires pre-approval or special forms, please notify and discuss with our staff before your surgery.

Claims

If we file your claim, we allow 45 days for the claim to be paid by the insurance company. After that period, we will ask that you work with your insurance company to pay any outstanding claims and will ask that you pay us directly at that time.

Financial assistance

If you do not have insurance or the ability to pay, a state agency or program may be able to assist you. Our office staff will be happy to provide you with more information.

Itemized statements

At the time of your visit, we will provide an itemized receipt of all charges and payments. You will need to retain this document as a record of your visit and/or use it to file for reimbursement from your insurance company. We will send you a monthly statement of your account as long as you have an unpaid balance with Texas Retina.