The healthcare industry is changing on a daily basis. Sometimes it is hard to get the answers you are looking for!!

Here are some helpful hints to help you try to understand your coverage and YOUR potential financial responsibility!

Definitions

Deductible: The annual amount that the insured must pay out of pocket for medical services before the health insurance carrier begins to pay. Medicare’s annual deductible for 2013 was $147; this will remain the same in 2014.

Copayment: A fixed amount that the insured must pay for covered benefits. This amount varies based on the type of service: for example, you may have a $20 copayment for a Primary Care Physician, $40 for a Specialist, and $100 for Emergency Room Services

Co-insurance: A cost-share between the insured and insurance carrier. For example, Medicare Part B pays 80% of all charges; the remaining 20% is the insured’s responsibility.

Medicare-Specific Information

Medicare Part A: hospital insurance, including inpatient stays, skilled nursing facilities, hospice care, and some home health care

Medicare Part B: medical insurance, including certain physician services, outpatient care, medical supplies and some preventative services

Medicare Part C: Medicare Advantage Plans, plans issued by private insurances (Geisinger Gold and Freedom Blue are examples) to supply your Medicare Part A and B coverage, and in some cases, Part D coverage. By opting into a Medicare Advantage plan, traditional Medicare no longer pays your claims; the Advantage plan you choose is the only Medicare coverage you will have

Medicare Part D: prescription drug coverage

Medicare Supplement Plans: Medicare only pays 80% of all covered charges; it is the patient’s responsibility to pay the other 20%. Medicare supplement plans can help pick up the extra 20%.

You may be asked to pay a copayment, deductible, refraction, or other fees at the time of service. For your convenience, we accept cash, checks, and all major credit cards. We appreciate your cooperation.

Never be afraid to ask questions!! If you are unclear about your coverage or benefits, contact your carrier’s Member Services.

Contact Information

Medicare

  • Part B Bills/Questions: 1-800-633-4227
  • Social Security Administration (update information, request new card): 1-800-772-1213
  • Coordination of Benefits: 1-800-999-1118
  • Website: www.medicare.gov

Medicaid

  • Department of Public Welfare: 1-800-692-7462
  • Lackawanna County Assistance Office: 570-963-4525
  • Website: www.dpw.state.pa.us

Affordable Health Care Act — Questions and Enrollment

Insurances Plans That NEI Takes

Medical Plans:

  • Advantra

  • Aetna

  • Aetna Better Health (medical--ophthalmologists only)

  • AmeriHealth Northeast  (medical visits only; non-par with Davis vision)

  • Cigna

  • Coventry Health Network

  • Federal Blue Shield

  • First Health Network

  • Geisinger (all products)

  • Highmark Blue Shield

  • Humana Gold (Medicare advantage only)

  • Medicare

  • MultiPlan Network

  • MVP (through Multiplan only)

  • PA Medical Assistance

  • PHCS

  • Railroad Medicare

  • Tricare

  • United Healthcare

  • United Healthcare Community Plan (ophthalmologists only for medical visits)

  • UPMC

Vision Plans:

(Participation is plan specific and may vary with your plan that we are the participating provider)

 
  • Block Vision

  • Davis Vision

  • EyeMed

  • Liberty Vision

  • NVA

  • Spectera

  • Superior Vision

  • VBA

  • VCP

  • VSP

To speak with a helpful member of our team regarding insurance coverage, please call Northeastern Eye Institute at (800) 844-6315 or complete the form on this page today.