Costs & Insurance
Attention Aetna Patients:
We understand that communications have gone out to some of our patients from Aetna and possibly Eyemed that states we are no longer participating providers on some of their plans. There have been no changes to our Aetna participation. The communication was triggered by an error in Aetna’s system which they are working diligently to correct. We expect this to be corrected by the end of this week. If you have an upcoming appointment, there is no need to cancel or reschedule.
Our mission at Horizon Eye Care is to enhance, restore and preserve vision. While protecting and enhancing your vision is Horizon’s top priority, we understand that many vision surgeries and procedures are financially significant. Having comprehensive financial information prior to making medical decisions is crucial. Please be aware that no surgery will be performed without a consultation in which we will go over costs in detail.
Before your visit, we request that you review all of the information we have collected below. If you feel that something is missing or have any questions, please do not hesitate to call us at 704-365-0555.
If you do not have insurance coverage for a routine eye exam, our fee is $180. This is a discounted rate available only when paid in full at the time of service. This fee includes the medical examination of your eyes and refraction. The refraction is the portion of the exam where the doctor determines the prescription you need for glasses. There will be an additional charge for contact lens fittings and checks.
If you do have insurance coverage for routine eye care and Horizon is a participating provider, there is a contracted reimbursement rate that we receive from your insurance company. We will bill your insurance company our standard charge, and you will receive an explanation of benefits from your insurance company.
Please note that if you have a deductible or co-insurance, your responsibility will be a portion of our contracted rate and not the $180 price described above. It is important to note that insurance companies frequently deny the refraction portion of your eye exam as a non-covered benefit. In these circumstances, the patient is responsible for the cost of refraction.
Refraction is the procedure performed by an eye doctor to determine the prescription needed for eyeglasses. We use either a phoropter, fitted with various lenses, or our Epic machine to perform the refraction.
As dictated by the federal government, refraction is a non-covered service that must be billed separately from the exam. Because Medicare has determined that this service is non-covered, some medical insurance providers have mandated the same policy. Medicare and most insurance companies require that patients pay for the refraction separately from the exam.
To find out if your plan covers refractions, please call the customer service number on your insurance card and ask if refraction services, represented by procedure code 92015, are covered.
As an alternative to the comprehensive eye exam, Horizon Eye Care offers optomap, a non-dilated eye exam that evaluates retinal health and the overall well-being of patients’ eyes quickly and painlessly. Most insurance policies do not cover optomap. Our current rate is $40, which is due at the time of service.
Patients who wear contact lenses require annual evaluations. During the exam, the doctor assesses your eyes to make sure your cornea, lids and lashes are healthy. He or she also checks to see if your vision with contacts is stable. If you are an existing contact lens wearer, the doctor must evaluate your current lenses to make sure they are still satisfactory in fit and vision.
For patients who have not previously worn contact lenses, the doctor will determine whether you are a candidate or not.
- Soft or Gas Permeable with or without brand change
- Re-validates your prescription for one year
- Soft or Gas Permeable
- Upgrade in lenses including Multifocal, Toric or Monovision
- Re-validates your prescription for one year
- Soft or Gas Permeable
- Includes Insertion and removal and 90 days of follow-up care
- Spherical, Toric, Monovision and Multifocal
- Includes Insertion, removal and 90 days follow-up care
- Keratoconus, Corneal Disease and medical treatment
Evaluation fees include insertion and removal instructions (if needed), initial solutions and up to 2 pairs of trial contact lenses. Follow-up time is allotted for you to complete your contact lens evaluation. Established contact lens wearers receive 30-day follow-up and a new contact lens wearer receives 90 days follow-up care. Contact lens technicians review contact lens wearer care to determine if follow-up is necessary. New contact lens wearers are required to have a follow-up visit 1-2 weeks after starting to wear the lens. If any eye problems arise, you must contact your doctor immediately. Improper use of contact lenses may result in permanent visual impairment.
All fees are due at the time of service and are non-refundable. Evaluation fees do not include the price of contact lenses.
Insurance - Coverage
Horizon Eye Care doctors participate in most of the major insurance plan networks in the area including those listed below. Some of these companies offer specific medical and/or vision plans that limit the number of participating providers, so it is best to check the provider directory that is specific to your plan to ensure our participation.
If your current health insurance policy does not cover vision care, and you find that you need it, consult your insurance company during the Open Enrollment period at the end of each year. A representative at the insurance company should be able to guide you. Take a look at the general list of insurance companies whose coverage Horizon Eye Care accepts.
Here is a general list of insurance companies whose coverage we accept:
- AARP Medicare
- Absolute Total Care SC Medicaid Plan (Medical Only)
- Advicare (Pediatric Medical Only)
- Americas First Choice Medicare
- Bind On Demand
- Blue Choice HealthPlan
- Blue Cross Blue Shield of NC (not including Blue Local)
- Blue Cross Blue Shield of South Carolina
- Blue Medicare
- Blue Cross Blue Shield National Network
- Federal Blue Cross Blue Shield (Medical Only)
- Blue Choice SC Medicaid Plan (Medical Only)
- Bright Health
- Care N’ Care (Medical Only)
- Care Improvement Plus Medicare PPO (Medical Only)
- Cigna Healthspring Medicare
- Community Eye Care
- Consumers' Choice Health Plan
- Evercare Medicare (Medical Only)
- Eyemed (Plans A-H)
- First Health PPO
- Humana Medicare
- Medicaid of NC
- Medicaid of SC
- Molina Healthcare SC Medicaid (Pediatric Medical Only)
- Select Health of SC Medicaid (Pediatric Medical Only)
- Wellcare SC Medicaid (Medical Only)
- PruittHealth Premier Medicare
- Services for the Blind NC
- Tricare (not including Tricare Prime)
- United Healthcare
- United Healthcare Medicare Plans
- Vision Service Plan (VSP)
Insurance – Copays, Deductibles and Non-Covered Charges
Our policy is outlined in our Patient Consent and Agreement Form, which all patients must sign before their appointment. Please take the time to read this in full and call us with any questions.
When you check in at our office, we receive an instant report from your insurance company that tells us about your benefits and financial responsibility. If you have not yet met your deductible or have co-insurance, we require payment at the time of service. It is Horizon’s policy to collect all co-pays and non-covered charges (such as for refractions) at the time of service.
Many insurance companies deem either part or all of your routine eye exams as a "non-covered" service, meaning you are responsible for the bill. The most common of these is the refraction. When verifying your coverage with your provider, ask if they cover refraction services, which is represented by procedure code 92015. To help our customers, we offer a "prompt pay discount" on refraction services if they are not covered by your insurance plan.
Your Rights and Protections Against Surprise Medical Bills
Read or print this document with information about your rights and protections against surprise medical bills.
For all questions regarding your bill, please contact a billing representative at 704-365-0555.
We have established a very competitive price and offer our patients the option of affordable monthly payments through a credit card company called Alphaeon. Alphaeon offers different financing options to make it easier for you to pay for procedures, treatments, products and services performed and offered by board-certified physicians. Your monthly payment and interest rate will depend on the terms of the financing plan you choose. They also offer a plan that charges NO INTEREST for up to 12 months. You can call 1-855-497-8176 for more information or apply online at https://goalphaeon.com/.