Insurance Information

Insurance Information

In general, artificial eyes are covered by insurance and most plans do not consider them to be cosmetic devices, rather Durable Medical Equipment (DME). However, most plans do have guidelines regarding replacements and benefits vary. Contact your insurance company for more information on your plan benefits.

MEDICARE: Prosthetic eyes and related services are covered procedures under Medicare guidelines. Prior to beginning your fitting, a letter of medical necessity from your ophthalmologist is required. This request can be in the form of a written prescription from your ophthalmologist or a letter stating that the procedure is medically necessary. There are co-pays and some other out of pocket expenses when using Medicare, and payment of these expenses is the responsibility of the patient, at the time services are rendered.

PRIVATE INSURANCE: Most insurances will pay at least a portion of the fitting and supply fees for your artificial eye. Most insurers will pay 60% to 90% of their company's allowed amount. This allowed amount varies from company to company, but it can be ascertained by reviewing the plan's policy or by calling the Member Services telephone number listed on your insurance card. Prior to your fitting, you will need a letter of medical necessity from your ophthalmologist in order for us to obtain authorization from your insurance company. Generally, the allowed amounts assigned by private insurers are below the office fee for service. The patient will be responsible for any annual deductible as determined by their policy and the 20% co-pay amount. Additionally, the patient will be responsible for the difference between the allowed amount of their policy and the billed charges, at the time services are rendered.

HEALTH MAINTENANCE ORGANIZATIONS (HMO): HMO's are unique in the respect that prior authorization must be obtained from your medical group prior to seeing the ocularist for service, and the authorization needs to be in hand before work begins. If you have questions regarding obtaining the prior authorization documentation for your artificial eye, please contact the office. However, remember this is your insurance and it is your responsibility to do the legwork to get HMO's referral to your ocularist.

Many insurance companies realize the value of offering patients coverage with a BCO, rather than with non-certified “Ocularists”.  You have chosen wisely in selecting Johnston Ocular Prosthetics, Inc.



Copyright @ 2011 Johnston Ocular Prosthetics, Inc., Last Modified: 03/05/2015