Privacy Practices*Iowa Eye Prosthetics*Board Certified Ocularist*Plastic Artificial Eye*Human*

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We are insurance providers for

      Blue Cross Blue Shield

      John Deere Premier

      United Healthcare of the River Valley

United Healthcare Networks with gap exception

      AmeriChoice Secure Plus Complete

      Heritage Choice

      Heritage Choice Standard

      Heritage Plus (EPO/PPO)

      Heritage Premier

      Heritage Select

      Heritage Select Advantage

      United HealthCare Hawk-I



      Midlands Choice-3rd party payee
           Cigna

           Midlands Choice coordinates many insurance carriers and you may be covered.

    VA-(The US Department of Affairs)-

    The VA provides patient care and federal benefits to veterans and possibly your dependents for custom fit artificial eyes. Contact your local VA to see what benefits may be available to you.

XIX

    AmeriHealth Caritas IA

    Amerigroup

    United Health Care Community Plan

Medicare-cleaning and polishing

We only accept assignment for 'cleaning and polishing' your eye prosthesis. You are allowed 2 appointments per year by Medicare .

Medicare-Non-Participating Provider

    for eye prosthesis

We are not able to accept assignment from "Medicare" for the eye prosthesis at the present time. We will be pleased to provide and file the information and receipts necessary for reimbursement of their allowable to you. Medicare’s allowable fee for a new eye prosthesis is just to low to accept.

We will try to confirm your coverage for you if we have the proper information.

To find out what your insurance plan covers and what your financial obligation may be, call the customer service or member services department of your insurance company (the phone numbers are on your insurance card). Your employer's human resources department may also be a source of information and assistance.

While you may have insurance coverage to pay your medical bills, you are ultimately responsible for all charges. You are responsible to notify us of your insurance and to provide the necessary information about your insurance plan.

It is your responsibility to know your insurance company's patient responsibilities and procedures. If proper procedures are not followed, you may be liable for full payment of the bill. If your insurance company requires a referral and/or prior authorization, contact your primary care physician prior to your appointment.

Benefit and coverage rules and policies differ among insurers and even between different plans of the same insurer. If you go to an out-of-network provider, your insurance company may only pay a percentage of the rates they determine are usual, customary, and reasonable (UCR) rates. It may be necessary to get a GAP Exception. You may be responsible for the full amount or the amount of charges over the insurer's UCR plus your usual deductible and co-payment.

Please contact our office for more information concerning you personally.

Home Procedure for Eye Prosthesis Procedure for Scleral Shell Prosthesis Care of your Artificial Eye Patient and Family Comments Maps/Hotels/Motels Payment Options Privacy Practices contact Vaune M. Bulgarelli David M. Bulgarelli Susan Hartman	Payment Options
	Contents of these pages are copyrighted and may not be reproduced in part or its entirety in any form for financial gain, without written consent from Iowa Eye Prosthetics, Inc.
	Payment Methods Cash Check *MasterCard* *Visa* Discover *We are insurance providers for* *Blue Cross Blue Shield* *John Deere Premier* *United Healthcare of the River Valley* United Healthcare Networks *with gap exception* *AmeriChoice Secure Plus Complete* *Heritage Choice* *Heritage Choice Standard* *Heritage Plus (EPO/PPO)* *Heritage Premier* *Heritage Select* *Heritage Select Advantage* *United HealthCare Hawk-I* *Midlands Choice-3rd party payee Cigna Midlands Choice coordinates many insurance carriers and you may be covered.* *VA-(The US Department of Affairs)-* The VA provides patient care and federal benefits to veterans and possibly your dependents for custom fit artificial eyes. Contact your local VA to see what benefits may be available to you. XIX AmeriHealth Caritas IA Amerigroup United Health Care Community Plan Medicare-cleaning and polishing We only accept assignment for 'cleaning and polishing' your eye prosthesis. You are allowed 2 appointments per year by Medicare . Medicare-Non-Participating Provider for eye prosthesis We are not able to accept assignment from "Medicare" for the eye prosthesis at the present time. We will be pleased to provide and file the information and receipts necessary for reimbursement of their allowable to you. Medicare’s allowable fee for a new eye prosthesis is just to low to accept. We will try to confirm your coverage for you if we have the proper information.** To find out what your insurance plan covers and what your financial obligation may be, call the customer service or member services department of your insurance company (the phone numbers are on your insurance card). Your employer's human resources department may also be a source of information and assistance. While you may have insurance coverage to pay your medical bills, you are ultimately responsible for all charges. You are responsible to notify us of your insurance and to provide the necessary information about your insurance plan. It is your responsibility to know your insurance company's patient responsibilities and procedures. If proper procedures are not followed, you may be liable for full payment of the bill. If your insurance company requires a referral and/or prior authorization, contact your primary care physician prior to your appointment. Benefit and coverage rules and policies differ among insurers and even between different plans of the same insurer. If you go to an out-of-network provider, your insurance company may only pay a percentage of the rates they determine are usual, customary, and reasonable (UCR) rates. It may be necessary to get a GAP Exception. You may be responsible for the full amount or the amount of charges over the insurer's UCR plus your usual deductible and co-payment. Please contact our office for more information concerning you personally. Back to top

Vaune M. Bulgarelli

Susan Hartman

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