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Financial Policies

Your Responsibility

You are financially responsible for the services provided to you. Most patients arrange for health insurance plans to pay for a large portion of their medical expenses. However, the patient or legal guardian is responsible to pay the fees for all examinations and treatments in the office or in surgery, in case your insurance carrier deems our services non-covered or not payable.

As a courtesy to you, we will file a claim to your insurance plan(s). However, we do expect payment of co-payments, (co- insurance, deductible, non-covered services/drugs, etc.) at the time services are rendered.

Payments will be collected either before or after the appointment. If you are unsure of your financial responsibility, please contact your insurance plan in advance to obtain this information.

Please remember that your insurance benefits is a contract between you and the insurance carrier. We will assist in filing any of your claims for you, but will look to you for assistance in expediting our claims in a timely manner.

Our insurance billing specialists are available to provide assistance that you may require and to help with an estimate of your financial responsibility.

Non-Covered Service Condition

Retina Center of Pensacola is dedicated to the preservation of your vision and treatment of your retinal condition. Since we are a specialty practice, some procedures that may be performed in your treatment plan could be deemed non-covered by your insurance plan.

We will file the services to your insurance carrier for consideration of reimbursement and provide all necessary documentation in support of the needed service.

In the event that these services are determined to be a non-covered service by your benefit plan, it is your responsibility to pay for the services rendered. Our financial counselors will be available to you to review these out of pocket expenses with you prior to services being rendered.

Prior Balance

Patients with a balance from prior services rendered will be required to pay that balance in full before being seen by Dr. Rifai. If the prior balance cannot be paid in full, you will be asked to speak with our financial counselors to make payment arrangement determinations based on our payment policy before being seen by the physician.

Patient without Insurance Coverage (Self-Pay)

Retina Center of Pensacola will provide medical services to patients who do not have insurance coverage. However, if you do not have insurance you will be expected to pay:

  1. A minimum deposit of a 1/3 of the estimated charges due the same day services are rendered
  2. A 1/3 of the balance will be due no more than 15 days from the date services are rendered.
  3. The balance will be due in full no more than 45 days from the date services are rendered.

If you are unable to pay the balance in full within the 45 days’ time period from the date services are rendered, please contact our financial counselors to ascertain how the debt will be paid.

Methods of Payment

We accept Cash, Checks, Visa, MasterCard, Discover and American Express. We now accept all Health Savings Account debit cards.

Returned Checks

Retina Center of Pensacola shall assess a $30.00 fee on all returned checks by banks for “non-sufficient funds”. We expect payment of the bank fee and the returned check before the next appointment.

Medicare Patients

Retina Center of Pensacola accepts Medicare assignment. We will file to your secondary and/or supplemental insurance, if you have provided us with the proper billing information. You are responsible for all applicable co-insurance, deductible and non-covered services including injectable drugs. In addition to the bill we send you, Medicare will also provide you with an Explanation with detailed information indicating the amounts you will owe.

Medicaid Patients

Retina Center of Pensacola accepts Medicaid assignment. A current Medicaid card must be presented at each visit. You will be responsible to pay the co-pay at the time of check-in. If you have exceeded the legislative limits for the year as set forth by Medicaid, you will be responsible to pay all charges for services performed.

If you have a Medicaid product that requires prior authorization it is your responsibility to bring your referral from your Primary Care Physician with you to the appointment. If you have the Medically Needy Medicaid product, it is your financial responsibility to pay any out of pocket expense until the share of cost is met.

Medicare Advantage (Replacement Part C)/ Medicaid Patients

If you are enrolled in a Medicare Advantage plan or a Medicare Replacement plan, also known as Medicare Part C, with Medicaid as the secondary payer, you are responsible for co-payments, co-insurance, deductibles and non-covered services and injectable drugs. Medicaid does not have approved funding to pay any balances remaining from these types of policies.

It is the responsibility of the patient to pay these remaining balances. We will not file these balances to Medicaid as they do not pay for these amounts.

Workers Compensation

Retina Center of Pensacola accepts Workers Compensation Insurance. It is your responsibility to provide the following information to our office prior to services being rendered:

  1. Name of your employer
  2. Contact name and number for your employer
  3. Date of injury
  4. Claim number if available

Any other information that will help to expedite the handling of your claims filing process.
Failure to provide this information will result in the patient being responsible for all services rendered.

HMO Patients

If Retina Center of Pensacola participates with your insurance plan, you will be required to pay for the applicable co-pay, co-insurance and/or deductible at the time services are rendered. When required by your HMO plan, you are responsible for obtaining a referral from your Primary Care Physician. If you do not have a proper referral/authorization you may be required to reschedule your appointment. If services are rendered without a valid referral/authorization, you will be expected to sign a “Waiver” and must pay under the conditions of a non-covered service.

  1. Minimum deposit of 1/3 of the estimated charges due the same day services are rendered.
  2. 1/3 of the balance will be due no more than 15 days from the date services are rendered.
  3. The balance will be due in full no more than 30 days from the date services are rendered.