North Suburban Vision Consultants is committed to providing our patients with the state of the art in medical eye care and vision care services. The services that we provide are comprehensive. Many services may be covered by your insurance carriers. Due to the presence of thousands of different medical and vision plans, the determination of what professional services are covered by your plan can only be determined by your insurance carrier. It is your obligation to know what benefits and limitations exist with your specific insurance plan. NSVC will assist you in any way that we can to get this information for you if you are unable to do so. Our staff and our associated billing and insurance coding professionals will do their best to help you get your maximum insurance benefits. You are responsible for any fees related to services and materials rendered that are not covered by your insurance company.
Medical Billing Service: NSVC utilizes an affiliated outside medical billing service to submit all claims to your insurance carriers. This service is comprised of experts in medical and vision care billing and coding to optimize your coverage. Questions related to billing issues should be directed to our billing service. Medical Group Services, inc. (MGSI) 877 896 6474
Insurance coverage for services and materials provided by NSVC fall into one of two categories:
- Medical Health Insurance for medical eye care services. Procedures, services, and tests related medical eye conditions with appropriate corresponding diagnoses can be billed to your medical health insurance carrier.
- Vision Care Plans for non-medical vision services and materials. Routine vision examinations, glasses, contact lenses, and contact lens related professional services can be billed to your vision plan if you have one.
We are on the preferred participating provider panels of most major medical and PPO plans, Medicare, a limited number of HMO plans, and a limited number of vision plans. To see if we participate in your insurance plan, please contact our business office. Most plans that we are not participating providers for often will still pay for covered services as well (at “out of network” rates and policies), however we can not guarantee this. For those few plans that we are not participating providers for, we will (via our medical billing service) submit for “out of network” coverage for you and request that the insurance company pays you directly. We require payment to NSVC by the patient when we do not participate in your insurance plan.
Medical health insurance plans (major medical, PPO, IPO, and most HMO's) will cover "medically necessary services," but specifically exclude "refraction" (testing for eyeglasses prescriptions), and contact lens related professional services. Most do not cover material costs for glasses or contact lenses either (unless they have a special routine vision care and treatment rider). These fees typically must be paid "out of pocket" by the patient. There are some circumstances when contact lenses may be "medically necessary" and therefore may be covered by medical insurance. Any out of pocket costs may be covered by a Flexible Health Spending Account that you may have.
Medical health insurance coverage for services provided by NSVC are subject to limitations of: deductibles, co-insurance, co-pays, and non-covered expenses. Patients are responsible for payment to NSVC for any of these expenses following determination by your medical health insurance carrier.
Vision care plans are intended to function as an added benefit to your medical insurance (similar to dental insurance). If you are fortunate enough to have such an added plan and we are participants in that plan, we will utilize the plan to your greatest advantage. Most of these vision plans are not intended to cover 100% of your costs for either vision services or materials, but end up providing a significant savings in comparison to usual and customary charges.
NSVC provides you with services above and beyond in regard to insurance claim submission!
As an additional service to you, NSVC, through its insurance billing and coding service, will submit each and every claim to your insurance carrier for services and materials provided to you and your family automatically. We will ask you for a copy of your insurance ID card at the time of your visit to NSVC. If we are preferred providers on your plan, then we will accept direct payment from your insurance for covered expenses. If we are not currently on your insurance company's list of preferred providers, we will ask you for direct payment, but as a courtesy we will submit in a claim to your insurance carrier for you. All of the paper work is on us! Payment will be directed to you automatically.