How much do optometry practices get reimbursed for a general claims (after adjustments) per insurance or vision plans. I have a client that wants to compare how much he is receiving from his different payer groups (BCBS, Medicare, Medicaid, Network Health, Eye Med, etc,..) versus the national average. For instance if they submit a claim for $100 and the payer reimburses them $70 the payment ratio is 70%.
#1 by isu_trickster on 11/30/2011 - 1:29 PM
It is going to boil down to the insurrance provider. It isnt necessarily a %, it may be a flat amount that the insurance company pays.
#2 by mbrcatz on 11/30/2011 - 1:51 PM
Vision plans usually reimburse a flat rate – like $70, plus your copay. They don’t reimburse on a percentage basis.
#3 by ஐ Miss Nikki ™ஐ on 11/30/2011 - 2:46 PM
It is completely dependent on the contracted amount the practices have with that particular insurer. These are called allowed amounts. They are not obligated to have contractual agreements with any or certain insurance companies, including Medicare.
Allowed amount vary depending on where the provider is located. For instance, an Optometry provider in Los Angeles, probably has a much bigger allowed amount with Insurers, than say an Optemetry Clinic in the middle of Montana.
#4 by Flower on 11/30/2011 - 3:12 PM
Medicare benefit is a pair of eyeglasses every two years in my Advantage plan. It was $150 every time but now it has gone up to $275.