Planning My Visit

Welcome! Thank you for choosing Shelby Eye Centers.  In order to ensure a smooth check-in process, please review the following information.

Before Your Visit

Please call your insurance provider with these questions:

1. Is Shelby Eye Centers in your network of approved providers.? (Dr. Stephen J Bogan/Dr. Nancy Cline)
2. What services are covered under your policy?
3. Do you need a referral for specialty care?
4. If you are interested in contact lenses is contact lens exam covered under your vision or medical plan?

What you need to bring for your visit

1. All insurance cards showing your current coverage-Medical and/or Eye Plan
2. Your glasses
3. Contact lens wearers bring a copy of the prescription you are currently wearing. We can also take information from boxes or foil packs.
4. Photo ID
5. Current medication list, including the dosage and prescribed instructions
6. Any Co-Pays
7. If you are a New Patient to Shelby Eye Centers we request that you see the section of the web page listed PATIENT FORMS. Please print, fill out, and bring the following forms with you to help ease to your check in process.
   1. New Patient Form
   2. Patient Privacy Acknowledgment
   3. Financial policy

When You Arrive

Please sign in at the front desk when you arrive. The staff will collect all the above mentioned information.  After check in you will be asked  to have a seat in our waiting room. There will be a short wait to allow the receptionist to check insurance and enter your data.  Once you are seated, please check back in with a staff member if you have not been seen in 20 minutes.

The Exam

Your exam will begin with one of our well trained Certified Ophthalmic Technicians. Once they call you into a room, they will enter or update all of your medical information, record any complaints or concerns, and begin your exam testing ending with dilation of your pupils if required.

After the dilation has taken effect you will be seen by the physician who will review your complaints and then proceed with appropriate testing. At the end of your examination you will be informed of your diagnosis and any questions you might have will be answered. You will be given a copy of your clinical summary which will also be available to review through our patient portal (please see Patient Portal tab for further information).

To better prepare for your exam we have listed below a few standard tests and various exams along with dilation requirements.

• New Patient Exam/Dilation required
• Annual Exam/Dilation required
• Return Exam /Dilation requirements are based on the reason for the visit
• Visual Field / No dilation required
• HRT or OCT/ No dilation (BUT if image is poor dilation maybe required)
• Fundus Photos or Fluorescein Angiogram /Dilation required
• Corneal Topography/ No Dilation required
• Pachymetry/ No Dilation required

Billing Your Exam

Billing for Routine Vision Examinations (versus) Medical Eye Examinations

The difference between routine vision examinations and medical eye examinations can be confusing and difficult to understand. There are, however, important differences between these two types of examinations and these differences determine how the office visit will be billed.

Q:        What is a routine eye examination?
A:        Insurance companies define a “routine” or “annual” vision examination as an office visit for the purpose of checking vision, screening for disease, and/or updating eyeglass or contact lens prescriptions.

Q:        Are routine exams covered by Medicare?
A:        By law, Medicare does not pay for routine vision exams or refractions

Medicare beneficiaries may choose to have a routine or annual eye examinations performed, but the patient is responsible for full payment for these examinations on the day of service.

Some Medicare beneficiaries may have “vision benefits” that cover routine eye examinations through their secondary or supplementary insurance.

Insurance coverage often changes from year to year however, and it is the patient’s responsibility to know what their insurance plans cover and what they do not.

Q:        What is a refraction? Is it covered under Medicare? Is it covered under commercial insurance?
A:        A refraction is the part of the office visit that determines the eyeglass prescription. Many times this involves the comparison question “which choice is clearer, choice one or choice two?” as different lens combinations are presented to the patient.

Medicare does not consider a refraction to be a “medically necessary” service, and therefore Medicare will not pay for this part of the examination.

Some secondary or vision insurance plans, however, will cover this service.

It is important to remember that the patient’s insurance coverage is an agreement between the patient and their insurance company; NOT between the insurance company and the doctor.

Remember, insurance “coverage” does not necessarily mean insurance “payment”. Many health plans have required copayments and deductibles that must be met before they pay anything towards the patient’s bill.

In general, it is best for patients with commercial insurance (whether primary or secondary) to check with their insurance carriers (calling the numbers printed on the back of their insurance cards) BEFORE their office visit to:

1. determine if they have vision benefits (and what those benefits are)
2. determine if our doctors are participating providers in their plan
3. determine whether or not refractions (determination of eyeglass prescriptions) are covered

Q:        If a patient has both medical and vision insurance, which gets billed?
A:        This depends on the reason for the visit

Examinations for medical care, evaluation of an eye complaint or to follow an existing medical condition are billed to the patient’s medical insurance plan.

Examinations for the purpose of checking vision, screening for disease, or updating eyeglasses or contact lenses are billed to the patient’s vision insurance plan, if the doctors participate in that plan.

Q:        When a patient presents for a routine vision exam (and this is the reason for the visit) and the doctor finds a medical eye condition, can the charges be filed to the medical insurance plan?
A:        No.  If the reason for the visit was for a routine vision examination, the visit cannot be billed to medical insurance per federally accepted billing guidelines. Therefore either:

1. the vision insurance is billed (if the patient has vision insurance and the doctors are participating providers in their vision insurance plan) or;
2. the patient is responsible for the examination fees on the day of service.

Subsequent office visits and testing (on a different day) for the purpose of addressing the medical condition that was discovered as part of the routine eye examination are billed to the medical insurance.

Q:        Is it ever possible to bill both medical and vision insurance on the same date?
A:        Occasionally

Some vision insurance plans will cover a refraction (see above) on the same date as an office visit for a medical condition (with the medical insurance covering the office visit).

We would again like to say we appreciate you choosing Shelby Eye Centers . We hope that this information will ensure that you have a pleasant experience on your visit. If we can do anything to help you further please feel free to call the office.