How can I check if I am eligible for a covered routine eye exam?
If you are planning to use your medical insurance plan to see the doctor for a routine eye exam, you can call the phone number on the back of your insurance card. You can also go online and log-in to your insurance account to check as well. Some insurance plans provide coverage for a routine eye exam once every other year, or once every calendar year. Every plan is different. Not all medical insurance plans provide routine eye exam benefits. NEO will help look up patient copays, but is not responsible for researching patient eligibility for routine contracted benefits. Patients are responsible for knowing their own insurance coverage and for all services rendered. To inquire the cost of an eye exam, please contact the office. Patients can also use their Flexible Spending Account (FSA) or Health Savings Account (HSA) towards their eye appointments.
Do I need a referral to see an optometrist (or a provider other than the primary care doctor) for a medical visit?
To clarify, a referral is not needed for a routine eye exam (or preventative care visit). However, it is important to understand how insurance works if you would like to apply your insurance to cover medical appointments. In general, medical insurance plans are set up with two options when you enroll.
PPO stands for preferred provider organization.
HMO stands for health maintenance organization.
If you are on a PPO plan you have the flexibility to see any health care professional without a referral from the primary care physician (PCP). If you are on a HMO plan you will need a referral before you can see any other health care professional, except in an emergency. To obtain a referral, contact your PCP’s referral department. The patient will have to provide NEO the Referral authorization code, Referring PCP’s name, address, and NPI (National Provider Identifier). Failing to provide the necessary information the insurance will not cover the visit. Please check your insurance before coming to your appointment to ensure insurance coverage.
What if my primary care doctor has not made the referral in time for my eye appointment?
If Northeast Optometry (NEO) does not have your referral by the day of your exam, your visit will not be covered by insurance. You will have to pay out of pocket on the day of your appointment, and an itemized receipt can be provided to you. It is the patient’s responsibility to make sure NEO receives the referral in time.
How often do I need a routine eye exam?
In general, it is ideal to get your eyes examined once every year or once every other year depending on the status of your eye health, age and if you have any systemic conditions. Please check out the newsletter for a more in-depth answer.
I want to see the doctor but am not sure how my insurance works and if they take it…
Currently the doctor takes Blue Cross Blue Shield, Harvard Pilgrim, Mass General Brigham Health Plan, Medicare Part B and Cigna. For any other insurances not listed, the patient will have to pay out of pocket on the date of service. An itemized receipt can also be provided to you if you would like to submit a claim to your insurance for out-of-network coverage. To inquire the cost of an out of pocket eye exam, please contact the office.
If I get a routine eye exam, do I get a glasses prescription or contact lenses, or both?
During your routine eye exam, the doctor will check for any vision changes, provide a glasses prescription if needed, and a wellness check of the eyes. A contact lens fitting is an additional service which can be done during the exam. Check out the newsletter section for more information on what a comprehensive or routine eye exam covers. Review the what a soft contact lens fitting entails and NEO’s policy’s for contact lenses here.
Can I use my vision plan for an eye exam?
Most vision plans cover routine eye care services only. Northeast Optometry does not participate in vision plans at this time. However, if you do have a vision plan and would like to use it, an itemized receipt can be provided for reimbursement. You can submit a claim for reimbursement when purchasing glasses from Perception Optical or for reimbursement for routine services if applicable. For questions about medical visits please click here.
How will I receive a medical bill after my visit?
Northeast Optometry will submit a medical claim to your insurance plan if insurance was provided. Any outstanding balances not covered by insurance will be sent by email. If you do not have an email, we will mail the bill to your home. You can make a payment online following the instructions on the medical bill. If you have any issues, please contact us immediately.
What happens if I don’t pay my bill?
When patients schedule appointments, they agree to cover any outstanding or non-covered services. Patients are financially responsible for any non-covered or denied charges and for co-pays, deductibles, and coinsurance not covered by their insurance. An “Afterpay,” 4 time installment plan (interest- free) is available on the payment page for those who need financial assistance. Failure to provide full payment, Northeast Optometry LLC, may refer the patient's delinquent account to a third party collection agency and may be reported to one or more of the national credit bureaus.
Our Contact Lens Fitting Policy
The payment for the contact lens fee for services provided will be charged on the date of service. If for some reason the contact lens trial is not available on the day of your exam, the office will order the patient a set of trials which normally arrives within a week. The patient may book a follow up appointment within the next week. For patients who start the contact lens fitting process on the day of the routine exam, they must complete their Contact Lens Fitting with a final prescription from the doctor within 30 days of their routine eye exam. For patients who need a second trial order, the period gets extended to 40 days. Postponing your final fitting beyond the grace period will result in a late fee of $50 per visit. Beyond 60 days of the routine exam will result in termination of the contact lens exam. The patient will have to book another routine exam and contact lens fitting if they would like a valid contact lens prescription.
Our Cancellation Policy
We value our patients and chair time spent with each person. Patients will be charged a fee for no shows, cancelling the same day of appointment or if a patient cancels after 9PM the night before appointment time. Patients will be fined $50 and any outstanding balances must be paid in full before your next appointment.
Constant rescheduling of appointment times affects our schedule and other patients’ ability to book. Please be respectful to the practice and staff. Abusing the online scheduling will also incur a $50 charge. We respect our patients time and our time should be respected as well.
How to use the Online Health Intake Form with Promptly
If you are a new patient or an existing patient who needs to update to your medical history please click here or access the link on the “Book an Eye Exam” tab. Under the REGISTRATION TILE you will be able to input your medical history prior to your upcoming appointment to streamline the check-in process. With this link you can also find any necessary consent forms and also update your demographic and insurance information.