After careful consideration, we are making the following changes. Effective November 1st, 2023 we will be an open access practice for Avesis & Superior Vision members and no longer contracted in-network. This means we will no longer bill Avesis or Superior Vision as a third-party, but will continue to provide eye care for all Avesis & Superior Vision members who choose Madeira Optical for medical, open access or direct care. Madeira Teachers are now on in-network with VSP and not affected.
Below are the options for current Avesis & Superior members. You have options and we would love for you to continue care with us.
You May Continue to Utilize Your Medical Plan For Medical Eye Health Care Services
- Avesis & Superior are vision plans and not medical health insurance. Vision plans typically charge monthly premiums, cover a periodic wellness exam and provide discounts on some, but not all, services and materials.
- If you have medical issues with your eyes or systemic diseases we probably already bill your medical insurance. Examples of such issues are diabetes, chronic dry eyes, cataracts, glaucoma, painful or red eyes, injuries to the eye, allergies or the use of certain medication. Please call us with questions about medical care and coverage. Medical health insurance does not typically cover materials. More on those options below.
Open Access Care at Madeira Optical:
- We will provide you with a copy of your medically coded paid invoice that you can use to collect available out-of-network reimbursement directly from Avesis. We can also help locate and complete your one-page Avesis claim form. Avesis will reimburse you directly. Most people find it pretty simple.
- If you choose this option, you are eligible for significant Madeira Optical prompt pay discounts when you play for services and materials on the day of your exam.
- You can use FSA or HSA benefits for most service and materials or pay with check, cash or credit card.
- your out-of-pocket expenses are typically similar to in-network, but every plan is different we encourage you to be an informed healthcare consumer.
Direct Care at Madeira Optical
- Vision plans are not really designed to cover unexpected costs. You either need corrective lenses or you don’t. You may choose not to utilize your employer-sponsored vision plan at renewal and save on the premiums you pay for, regardless of whether you get care or not. Some employers cover the premiums, so please check that. Most eye care services and materials are not taxed in Ohio.
- If you choose this option, you are eligible for significant prompt pay discounts when you play for services and materials on the day of your exam and you can go any time between visits and not lose benefits you paid for through your premiums.
- You can use FSA or HSA benefits for most service and materials or pay with check, cash or credit card.
- your out-of-pocket expenses are typically similar to in-network, but every plan is different we encourage you to be an informed healthcare consumer.
Switch to a Contracted or Owned In-network Provider
- We will transfer your records with your permission to your new provider at no cost from now until 12 months after this transition date.
- Unfortunately, we realize we were one of the few leading independent practices who was contracted with this provider, but this model no longer makes sense for the type of care we provide.
- Here are a few questions to consider if you seek an in-network provider.
- How long are your exams? Some providers may only offer 15-20 minute exam appointments. We feel like a 30 minute exam is appropriate.
- Will I generally be followed by the same doctor? Some practices can have higher doctor turnover, doctors who jump around between locations or scheduling philosophies that focus on filling first available appointments.
- What pre-tests are standard? Some providers may lack state-of-the-art diagnostic and treatment equipment typical at leading independent eye care facilities.
- Your uninterrupted eye care is our primary concern. Please let us know if you need any assistance during this transition of billing relationships. You can always choose care at Madeira Optical and we will try to help you find an in-network provider if you have specific needs.
- There are many good eye doctors at commercial practices, so please ask around for referrals.
Thank you for your careful review of this important update. Please forgive us for multiple communications on these billing and contracting changes (including emails, our blog and social media), but we want to make sure you can make a timely and informed choice for you and your family.
We feel strongly that as the health care environment evolves, these changes will help us care for patients who choose us with the most cost-effective and best care possible. We regret any and all inconveniences and remain hopeful for a better healthcare environment for all in the future.
Sincerely,
The optometrists and eye care team of Madeira Optical