Billing Information

Insurance Information

Eye Care and Laser Surgery currently participates with (accepts) the following insurance plans:

AARP / United Health Care
Medicare Replacement / Advantage Plans – Most Carriers
Aetna
Bankers Life
Blue Cross Blue Shield (CONFIRM WITH YOUR INSURANCE)
Cigna Health Plan (CONFIRM WITH YOUR INSURANCE)
Fallon Medicare Plus Supplemental Plans
Harvard Pilgrim Health Care (CONFIRM WITH YOUR INSURANCE)
Health Plans Inc
Mass General Brigham

Mass Health (ACO Medicaid) (except as listed below)
Medicare – Part B
Tri-Care
Tufts Health Plan (CONFIRM WITH YOUR INSURANCE)
Tufts Medicare Preferred
MGB DSNP
UMR
Wellpoint
United Health Care (CONFIRM WITH YOUR INSURANCE)

Eye Care and Laser Surgery currently does not participate with (accept) the following insurance plans:

Any Vision Care Insurances, such as Eye Med, VSP, etc.
Blue Cross –
- BC Advantage High Perform Limited Network
- BC Anthem ME Pathway HMO POS
- BC Anthem Pathway HMO POS
- BC Select Limited Network HMO
Harvard Pilgrim
- BIDMC Select
- BMC Select
- BILH Domestic Community HMO
- NH Local Choice
- NH Local Choice HMO
- Quality Limited NTWK HMO
- Elevate Health HMA / HSA
- First Seniority Freedom Plan
- Focus Plan
- Medicare Enhanced Plan
- Primary Choice Plan
- Select HMO
Mass Health (Connector Care Plans)
- BMC
- CeltiCare Health (Ambetter)
- Health New England
- Minuteman Health
- Tufts – Network Health
- Tufts – Public
- Tufts – Direct

Mass Health
- BMC
- Childrens Medical Security Plan
- Fallon
- Family Assistance
- Health Safety Net
- Limited
- Network Health Forward / Together
Out of State Medicaid
Tufts –
- Public Plans
- Select Network Plan – All Plans
- Spirit Plan
- Steward Community Choice
- Network Health
- Uniformed Services Family Health Plan
United HealthCare
- Evercare Plan
- Medicare Complete (HMO / PPO)
- Compass Plans
- Heritage Plans
- Indemnity
- Mid-Atlantic Gated HMO
- National Ancillary
- NHP Plans
- UHN ONENET
WellSense
Worker’s Compensations

Please note, the insurance plans we participate with (accept) are subject to change without notice. Additionally, you should always check with the member services department of your insurance carrier to determine if a specific physician is an approved provider.

Referral Requirements

It is of the utmost importance that you ensure your plan’s referral requirements are met before your visit.

If you have an HMO plan, you must have a referral to see one of our doctors (with exceptions)
- If you have THP, BCBS, or HPHC Commercial and have a Mass General Brigham PCP, you do not need a referral (please call us if you have questions regarding this)
If your primary care physician (PCP) is part of a restricted network, there are stringent requirements to see doctors outside of your network, making it vital that you contact your PCP well before your appointment to ensure that your visit to ECLS is covered by your insurance
To obtain a referral, call your PCP and provide the ECLS doctor, appointment date, and reason for the visit scheduled
If you have THP, BCBS, or HPHC Commercial and have a Mass General Brigham PCP, you do not need a referral (please call us if you have questions regarding this)

Please note, it is the patient’s responsibility to understand the requirements of their insurance plan. If a referral is not obtained, you will need to sign a no referral document, typically within 30-60 days, the bill will become patient responsibility.

If you have a United Healthcare plan that requires a referral, you must have a valid referral in place at the time of your visit. United Healthcare has very strict referral guidelines, and we are unable to see patients without the required authorization.

We understand that the referral process can be confusing. Please, do not hesitate to call us with any questions regarding referrals.

Insurance Checklist for Your Visit

By following this checklist, you can help ensure that the billing process is stress-free and done correctly.

For HMO plans, call your PCP and request a referral at least 5 days prior to your visit
Identify and understand your plan’s limitations, deductibles, coinsurance and copayments that may be required or incurred at your visit with an ECLS doctor
Bring all of your insurance cards to the visit to ensure accurate billing to your plan.
Be prepared to pay by debit/credit card/cash for any required co-payment at the time of service

Out of Pocket Costs

There are some out of pocket costs that may be incurred during your visit. These can include:

Refractions to determine your eyeglass or contact lens prescription
Contact Lens fittings
Specialty Lens for Cataract Surgery
LASIK Surgery
Contact Lens evaluations
Intense Pulse Light therapy IPL
Radio Frequency RF
Lipiflow
Tear Care
The use of reversal or non-dilating options
The purchase of products such as Optase Heat Mask or Avenova Spray

Please note, all out-of-pocket costs must be paid at the end of your visit.

There is a $75 no-show/cancellation fee. To avoid this fee, patients must cancel at least 24 hours before their appointment.

Frequently Asked Questions

What is the difference between routine visits and medical visits?

The specifics of medical insurance can be confusing, and vision coverage is no exception. Insurance companies usually categorize visits to your eye doctor as either “routine” or “medical”. This has little to do with the steps it takes to perform a full eye exam. A “routine” vision exam often contains the same elements as a “medical” eye exam. The reason for your visit and the results of the examination, or the diagnosis, often determine whether insurance will classify the exam as routine or medical. Insurance companies often look at both when determining payment. The routine vision exam usually produces a final diagnosis, such as “nearsightedness” or “astigmatism”, which generates a prescription for glasses. On the other hand, the medical eye exam produces a diagnosis of a medical condition, such as “dry eye”, “conjunctivitis”, or “cataract”.

What is a deductible?

This is the dollar amount you must pay before your insurance company begins to pay for health services. The amount of your deductible is determined by your insurance company when you choose your policy.

What is coinsurance?

Coinsurance is the share/percentage of covered expenses you are responsible for paying in addition to the copay and/or deductible. For example, your policy may pay for 80% of covered charges after you pay the deductible. You would then be responsible for paying the remaining 20% as coinsurance.

What is a copayment?

A copayment is a specified dollar amount you, as a subscriber, pay to a managed care plan for covered health services. Copayments are always paid to the medical provider at the time services are rendered.

Can I Pay My Bill Online?

Yes, we have online bill payment available here: https://pay.balancecollect.com/m/eyecareandlasersurgery