All charges are to be entered in the patient’s ledger on the day of services, regardless of whether the patient or insurance will pay. The patient’s vision or medical insurance may affect the amount the patient will pay at the time of their visit to the Clinic. The financial class field on the patient’s computer record should reflect the patient’s insurance and, in some instances, the Billing Department will append an insurance screen to the patient screen in the computer.
UCBSO is a provider for:
- “Straight” Medi-Cal
- Blue Cross (VSP Medi-Cal)
- Alameda Alliance (VSP Medi-Cal)
Clinic provides for Medi-Cal for Alameda County but not for Contra Costa or Solano County HMO plans. Patient should arrive with their Medi-Cal card and the staff will check eligibility via the internet to obtain authorization.
Medi-Cal charges are as follows:
- Examination – $111.00, $39.44 is paid by insurance.
- Frames – $21.31 is paid by insurance.
- Lenses – Single vision are billed at $57.00 ($21.54 paid). Bifocal lenses are billed at $85.00 ($31.80 paid).
Medi-Cal will cover a comprehensive eye examination every 2 years for the patient unless there is medical necessity which requires review by the billing department. No medical diagnosis is required for this benefit. They will also pay for one pair of eyeglasses (Medi-Cal frames) every 2 years. They will cover sooner than that if an Rx change meets their minimal requirements. Minimal Rx Change Medi-Cal guidelines: 0.50D change total (i.e. in one eye only or 0.25 in each eye). The materials benefit is only for children under 21 years of age.
Medically necessary contact lenses are covered ONLY WITH PRIOR AUTHORIZATION for children under 21 years of age.
E/M office visits (99___ and 92___ codes) are covered by Medi-Cal.
No medical procedures (these usually have their own separate procedure codes) are covered by Blue Cross or Alameda Alliance Medi-Cal plans (the plans administered by VSP). However, most procedures are covered by “Straight” Medi-Cal. Check your patient’s insurance information BEFORE scheduling in Med Mod. If Blue Cross or Alameda Alliance Medi-Cal patients are in need of a procedure, refer them to Highland or another facility which does accept their particular Medi-Cal plan. Procedures include things like lasers, chalazion removal, ultrasound, FA, PI, subtenon’s injection, YAG, most procedures which have their own procedure code. However, please note that visual fields and STEREO photos are permitted (OCT is not). It is always better to ask the front desk staff or a staff member in Insurance if you have a question.
Due to changes in the Medi-Cal system, the full fourteen-digit Medi-Cal number must now be used at all times. When a patient with Medi-Cal checks in for an appointment or assistance of any sort, we must always scan their card and obtain a Medi-Cal authorization that day. If we bill for services or materials for a patient without using the fourteen-digit Medi-Cal number, the insurance claim will be denied. If a patient can not produce their Medi-Cal card at the time of service (with the fourteen-digit number), the patient should be advised that they can keep their appointment but will be required to pay the cash price that day. The patient would also have the option to reschedule their appointment for another time. Please remind all Medi-Cal patients that they must bring their card to every visit.