Billing & Insurance

The Physicians at Pediatric Ophthalmology and Adult Strabismus, Surgical Associates have always made every effort to provide the highest quality care at a reasonable cost. In an effort to continue to minimize our patients’ cost of visits, we have the following billing policies:

Payment at Time of Service

Whomever will be responsible for the payment of the visit, we ask that you pay in full at the time the service is delivered. This will permit our staff to concentrate on providing the best possible eye care, rather than billing.

Patient Responsibility & Insurance Claims

***It is recommended that patients verify that our office is in-network for their policy; especially if this is their first visit or if their policy has changed since their last visit. Please give the following National Provider Identifications (NPI’s) to your insurance company and they can tell you whether we are in or out of network:

Examinations: 1285665356

Eyeglass/Contact Lens Materials: 1003022427

Insured members are responsible for knowing their network status, eligibility, and coverage cost. As a favor, our office will attempt to help by looking this information up on your behalf prior to the exam date.

In the event that insurance does not cover any service provided, members are then responsible for payment. All balances are to be paid within 60 days, and are subject to a $25 service fee for overdue balances older than 90 days.

Our office will assist you by filing insurance claims on your behalf if you have coverage. If medical visits are covered by a third-party insurance company or an HMO, you should be aware of the reimbursement policies of your insurance carrier. Each care plan has separate rules for authorization, payment, and handling of claims. These plans can and do change without notice.

Insured members should carry appropriate identification cards to enable you to receive all of the benefits that are available. It is your responsibility to bring all necessary referral forms, current insurance cards, authorizations, and the patient's social security number with you for each visit to our office.

Medical insurance covers medical conditions and surgeries. Vision insurance covers routine vision exams, and cannot be used if there is an underlying medical condition present.

Patients may also need to be refracted during their office visit. This service became excluded from the Evaluation and Management Codes standards in January of 1998. Since then, refractions have been a non-covered service by Medicare guidelines. Due to this, members have become responsible for the payment of refractions.

Accepted Insurance Plans

Most major insurances are accepted for medical examinations, including:

Aetna Medical
Cigna (no longer in network after 12/31/2021)
Gateway (Medical)
Highmark/BCBS
Medicare
Medicaid
United Healthcare (Medical)
UPMC Health
UPMC for You/Kids

Separately, our Eyewear Department accepts many Vision Insurances for glasses and contact lenses, including:

Davis Vision
Eyemed
National Vision Administrators (NVA)
PA Medicaid/Access
UPMC For You/Kids (Envolve)
UPMC Vision Advantage
Vision Benefits of America (VBA)
Vision Service Plan (VSP)

It is still recommended that patients verify our network status. For example, while we take most Highmark/BCBS and UPMC Health plans, there are subsidiaries within those plans which we do not accept.

Your understanding and cooperation in these matters is appreciated by all of our staff.

Questions regarding billing should be addressed to the billing department at 724-772-3388, Monday - Thursday, 9:00 am to 3:00 pm.

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