BUSINESS OFFICE POLICIES OF THE SPOKANE EYE CLINIC: 

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At Spokane Eye Clinic (SEC), we recognize the importance of our patient’s role in knowing and understanding the issues that affect the total cost and out-of-pocket cost of care they receive. We have developed the following written policies to ensure that all of our patients understand the services our Business Office provides and the rights and responsibilities our patients have with regard to payment for services.   

Insurance Benefits, Covered Services and Eligibility:   

SEC is contracted as a Participating Provider or Preferred Provider with more than 25 health Insurance Plans (Plans). Many of these Plans offer more than one insurance product, often with specific limitations. It is the responsibility of the patient to know his or her insurance coverage. Specifically, you are responsible for: 

• Obtaining a referral if necessary prior to seeing the doctor; and
• Determining that you are eligible at the time of service if covered by medical insurance; and
• Knowing what services (benefits) are covered and what services are not covered by your Plan; and
• Knowing if authorization is required in advance of surgery; and
• Payment of all co-payments, co-insurance and deductibles.  

If you have not already done so, please familiarize yourself with your insurance benefits and cost sharing agreement. If after contacting your Insurance Plan you still have questions, our Business Office will gladly work with you and a representative of your Plan to resolve your questions. We will need you to provide us with the information contained on your insurance card.  

Insurance Plans: 

The following is a list of Insurance Plans that SEC has contracts with as of September 2004. This list is subject to change without notice. Please contact our Business Office at 456-0107 to inquire about our doctors’ participation with your Plan, if it is not listed below.   

Aetna Health Plan
Asuris
Blue Cross of Idaho
Blue Cross of Washington and Alaska
Cigna   
Community Health Plan
Champus
Department of Social and Health Services (Washington Medicaid)
First Choice
First Health Group
Group Health (referral required)
Idaho Medicaid
Indian Health Plan
Labor and Industries
Medicare
Molina
PREMERA
Private Health Care Systems
Railroad Medicare
Regence Blue Shield
Spokane Physician Hospital Community organization
Sterling Options
TriCare
Uniform Medical Plan
United Healthcare
Veterans Administration (VA) (referral required)
Vision Service Plan
Washington Labor and Industries

Insurance Billing and Statement of Account: 

If SEC is contracted with your Plan, you will receive a statement of account by mail disclosing any balance due after we have billed your Plan and it has processed your claim. Our charges will be listed on the statement along with any payments made by your Plan and contractual discounts required by our contract. This statement should also correspond to the Explanation of Benefits (EOB) you receive in the mail from your Plan. You will receive an individual statement of account on a monthly basis. Payment is due upon receipt. Charges unpaid after 60 days will be charged a rebilling fee of $4.00.  

Payment and Credit Arrangements: 

If you are age 18 or older, you are legally responsible for the charges you incur regardless of who you may live with or the Guarantor of your Insurance Plan. Parents are financially responsible for the charges incurred by their children under the age of 18.  

If you do not have insurance, or if your insurance coverage is with a Plan that SEC does not contract with, you will be asked to make a deposit against the charges you will incur. The Business Office is available to assist with an estimate of your charges, but an exact amount may not be known until the services are provided. You will be mailed a statement of account disclosing any balance owed in excess of your deposit amount.