Billing & Insurance

Peace of Mind – We Accept the Following Insurance Plans and Offer Competitive Self-Pay Rates

Retina Specialists of Tampa accepts many types of insurance. Whether you have Medicare, managed care, or private insurance, it’s likely that your insurance will cover all or some of the services you receive. Patients are encouraged to discuss payment options with our staff.

Insurance Providers

• Aetna  HMO/PPO/POS/EPO
• AARP
• BCBS
• Cigna (NO BAYCARE) No Pursue Good Health
• Devoted
• Florida Hospital Employees
• Fortified
• Humana PPO/EPO (NO GOLD PLUS)
• Magellan
• Medicaid Share of cost (Must bring in Share of cost Letter)
• Medicare

• Meritain Health
• Molina
• Oscar
• Prestige (No WellCare, No Sunshine)
• Prime Health Services
• Railroad Medicare
• Simply
• Stay well
• Tricare (No Prime)
• United Health Care (No Navinet)
• Wellcare Medicaid
• Wellmed

Indicated Insurances may require a referral or authorization before making an appointment.

Another payment option is CareCredit®, you no longer have to wait to get the attention you deserve, we invite you to apply online, over the phone, or come into our office and we will be glad to help you.

Working with You and Your Insurance Company

There is no question that access to quality healthcare is crucial. The rising cost of health care and insurance leaves many people wondering whether they can afford to protect themselves in the event of sickness or injury. Retina Specialists of Tampa is committed to working with as many health Insurance companies as is financially feasible in order to make sure you get the care you need.

We want to make your appointment as pleasant as possible, so to help us best accommodate you, please bring your most recent insurance card(s) and any required referrals. It is the policy of this office to expect payment for services as they are rendered.

We will be happy to file a claim to your insurance, provided we participate with your plan. We participate in many medical plans and are Medicare providers. For additional information concerning accepted healthcare insurance plans, please refer to the list on the right side of this page. Should you have any questions regarding your plan, please contact us.

Retina Specialists of Tampa works with as many insurance companies as is financially feasible and is an approved provider for most insurance plans.

We also accept Medicare insurance. (you will only be responsible for what Medicare does not cover.)

The list above is our current health insurance companies with whom we work. Please check the list and see if your company is included. Please call us if you have any questions.

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.  You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.

Your health plan generally must:

• Cover emergency services without requiring you to get approval for services in advance (prior authorization).
• Cover emergency services by out-of-network providers.
• Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
• Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

Good Faith Estimate Disclaimer

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created.

The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.

If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill.

You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

To learn more and get a form to start the process, go to www.cms.gov/nosurprises/consumers or call 1-800-985-3059.