Insurance & Billing
ALTOS EYE PHYSICIANS BILLING POLICIES
For your visits and surgery, our office will bill Medicare for you electronically. Medicare will pay you, and confirm whether they have forwarded the claim directly to your second insurance (which they typically
do). If not, send a copy of the Medicare summary notice to your second insurance. Alternatively, our office can bill your Medicare supplement plan if you provide us with this notice. You may wait until you receive your insurance reimbursement before paying our bill.
We are “in-network” providers for many major PPOs, including Blue Shield, Blue Cross/Anthem, Aetna, Cigna, and United Healthcare. This means for those PPO insurance plans, our rates are set by the insurance company and you will generally have a lower co-pay and deductible because you went to an “in-network” physician. We submit the claim electronically for these PPOs.
These same companies also have HMOs and these plans limit you to a smaller, restricted list of physicians. Being in private practice we are excluded from participating in most HMOs. This means your HMO won’t cover exams or surgery by us, and you would be paying out of pocket. For example, Kaiser is an HMO and does not cover doctors outside of the Kaiser system. This is why it is so important to understand the type of insurance that you have prior to scheduling an appointment.
SCCIPA Santa Clara County is the one local HMO provider that does permit you to see independent private practice physicians. We are members of SCIPA. Like all HMOs, however, your visit will not be covered unless you obtain prior approval from your HMO to be seen by us. You must ask your primary care physician to initiate this approval process.
SURGERY BILLING: Dr. Chang’s surgery fee covers the initial postop visits. Charges for the initial eye exam and the “A-scan” lens implant measurements (separate for each eye) will be billed and reimbursed
separately through your insurance.
The Peninsula Eye Surgery Center and the anesthesiologist will also bill Medicare or your PPO insurance for you. They are in-network PPO providers for Blue Shield, Blue Cross/Anthem, Aetna, Cigna, and United Healthcare. Medicare usually pays the Surgery Center and the anesthesiologist directly. Their fees (separate from the surgeon fee) should be covered by your insurance depending on your plan benefits.
NON-COVERED LENS IMPLANT UPGRADES: Health insurance covers cataract surgery with a basic single focus intraocular lens implant. Patients may instead elect a premium refractive lens implant by paying the additional non-covered costs out of pocket. This optional upgrade does not affect the health of your eyes, but should improve your ability to see without glasses. The additional out-of-pocket cost will vary depending on which lens is selected and will be explained at your visit. It should be paid prior to surgery.
You may now pay your bill by check (payable to David F. Chang MD, Inc) or credit card online at www.altoseye.com/online-bill-pay/. We are always happy to assist you with any billing or payment questions. Please call 650-948-6506 or email Bookkeeping at firstname.lastname@example.org