Do you accept my insurance?
We accept Medicare as well as many PPO health insurance plans. Please consult the list below to see if we are in-network with your plan.
We are in-network ONLY with the plans listed below:
Covered California PPO:
- Aetna
- Anthem Blue Cross of California
- Blue Shield of California
- Cigna
- Health Net Commerical
- TriCare
- United Healthcare
Covered California HMO:
- Alignment Healthcare
- Brand New Day
- CareMore
- Excel MSO
- Imperial Health Plan
- Northern California Physician Network
- NX Health Network
- Physician Medical Group of San Jose
- Santa Clara Family Health
- San Jose Medical Group
- Verity Health System
*We are NOT in network with Santa Clara County IPA or Valley Health Plan*
We are not in-network with Anthem / Blue Cross mirror plans that utilize the same network as the Covered California plans. These plans will have “pathway” listed on the bottom front of the card.
Please make sure to notify us of any changes in your insurance before your appointment.
For payment, we accept all major credit cards, cash or personal checks.
For patients without insurance, we also accept Care Credit and can assist you in applying for an account if necessary. If special payment arrangements are needed, please contact our office staff prior to your appointment.
Billing
In an effort to clarify billing, which can be confusing, we have put together an explanation of some billing procedures and a key to terminology. Hopefully, this will help reduce confusion and allow you to better understand your statements.
- CPT Code The 5 digit number under “procedure” is the code used by all insurance companies for the type of service. Service includes exams, tests, and procedures.
- Duplicate CPT Codes Some CPT codes appear twice on the same day because some insurance companies require each eye be billed separately.
- ICD-10 code Designates the particular diagnosis, disease, or condition that was treated. There may be several ICD-10 codes listed if there are multiple diagnoses.
- Charges Amount billed to the insurance company. These are not the actual amounts paid. They are based on the usual fees that we charge for a service.
- Insurance payment Amount that has been paid by insurance for a claim based on the contractual allowed amount under your specific benefits.
- Allowable The contractual “allowed amount” for each procedure or service. It is the maximum the insurance company will reimburse for a service.
- EOD or Explanation of Benefits Once a claim has been processed by an insurance company, they send us a payment and an EOB. You should also receive an EOB.
- Contractual adjustment or Adjustment The difference between the amount allowed by insurance and the charges billed by our office. This is the amount written off by us.
- Patient responsibility The co-pay plus the percentage of the allowable charges that you are responsible for. This may also include your deductible.
- Deductible The dollar amount that must be paid by the insured before the insurance company begins to pay. Usually, it is a fixed amount every year and may vary.
- Balance The total amount that you are responsible for based on the EOB received from your insurance company, your deductible, and co-pays, and any previous unpaid balances.
- From the time that a payment is mailed, it usually takes 3-5 business days before it is posted to your account. Checks should be written out to “South Bay Retina”. Payments made by phone or in person are posted immediately.
If you have questions regarding your specific benefits like deductible amount or coinsurance, please contact your insurance company.
