Medicare Coverage Notification

General Rules

You must pay an annual deductible toward any qualified health care before Medicare will pay for any services. After the deductible has been met for the year, Medicare will pay 80 percent of their approved fee. You will pay 20 percent as a copayment, plus the fees for any non-covered services. If you have supplemental insurance (such as Blue-Cross Blue-Shield) it may cover the cost of the deductible and copayment. We will bill Medicare and your supplemental insurance carrier if the services qualify for Medicare coverage (see exceptions below). Charges not covered by Medicare are payable at the time of the visit.

Special Exceptions

  1. Medicare does not cover the refraction portion of an eye examination or refractive visits.
  2. Medicare does not cover eyeglasses or contact lenses unless the patient has had cataract surgery.
  3. Medicare does not cover any services unless there is a medical complaint or medical reason to return for the service. If your ONLY diagnosis is a visual (near or farsightedness, astigmatism, or presbyopia), Medicare will not pay for any services.
  4. Medicare may deny benefits if they feel you are receiving examinations too frequently, or are receiving exams by more than one doctor for the same illness.
  5. Your signature on this form will serve as your “signature on file” for processing Medicare claims and your supplemental insurance.

For Eyewear Following Cataract Surgery

The Medicare program provides standard eyewear frames up to a certain amount and standard multifocal lenses. I understand that these standard items are available through Eye Associates of Iowa City, P.C., I have chosen to select a frame and or lens that is above this allowance and agree to pay the difference in cost for the deluxe frame or multifocal lens.

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