(301) 770-4636
Lawrence S. Frank, MD
Seema A. Gupta, MD

Insurance


As of 2012, our office ONLY accepts medical insurance, and no longer accepts vision plans. Due to this change, the only type of visit that is covered by medical insurance is a medical eye exam. Routine eye exams will not be covered by medical insurance at our office and will require patients to pay out of pocket. Nearsightedness, farsightedness, and astigmatism fall under the category of refractive services and DO NOT qualify as medical conditions.

For more information on routine vs. medical eye exams, please click here.

We participate with most major medical insurance plans, including Medicare. Please call our office for more details and to see if we accept your plan.

We do NOT participate with the following plans:

We do NOT accept any vision plans, including but not limited to Davis Vision, Blue Vision, VSP, NVA, Spectera, EyeMed, or Avesis.

HMO Referrals

It is the patient's responsibility to check to see if a referral is needed and to obtain an appropriate referral for his/her visit. We will not be able to see you if a referral from your PCP is not received at the time of visit. You are welcome to reschedule your visit for a date after you expect to receive your referral. Referrals are usually required for HMO plans:


For patients who need a referral, please make sure "Evaluate and Treat" is listed as the reason for the visit. Referrals are not valid for insurance purposes if listed as "Routine."

The list of insurances above that our office does not accept is NOT a comprehensive list. Our office does NOT accept insurance plans that are issued through a Managed Care Organization (MCO), such as Medstar, Riverside Health, Amerigroup, Kaiser Permanente, United Healthcare HMO, and Maryland Physician Care. We DO, however, accept Cigna Healthspring.

In addition, we only accept federal and state issued Medicare and Medicaid plans. We do NOT take Medicare Advantage Plans. If you have either of these insurances, your insurance card should look like the ones shown listed below:

Medicare Card Maryland Medicaid

 

Left: Medicare card example.
Right: Maryland Medicaid card example.

 

Deductibles and Co-pays

As of 2015, our office requires patients to pay for any deductibles, copays, or coinsurance associated with their insurance plans. The following outlines a brief description of each of these:

Deductible: The deductible is a fixed annual out-of-pocket cost that your insurance company requires you to pay before their coverage begins. This means that you must pay the full amount of your deductible before your insurance will begin to pay for your medical expenses. Depending on the type of plan you have, your insurance may only require you to pay your deductible for certain types of medical visits.

Copay: Once you have met your deductible, or if you do not have a deductible, the copay is a fixed cost that you are required by your insurance to pay for each office visit you make. Copays will vary based on the type of office you visit (primary care, specialist, hospital, etc.) and the type of insurance plan you have.

Coinsurance: Some insurance plans will require you to pay a percentage of your office visit. The percentage you owe will be determined by your insurance company and will vary based on the type of medical visit.

For more information regarding deductibles, copays, and coinsurance, please click here. 1

Reference:

1. Blue Cross Blue Shield Blue Care Network of Michigan. (n.d.). How do deductibles, copays, and coinsurance work? Retrieved from
    http://www.bcbsm.com/index/health-insurance-help/faqs/topics/how-health-insurance- works/deductibles-
    coinsurance-copays.html