Cost and Insurance

The initial consultation is usually covered under most medical insurance companies. If your insurance covers this, you will be responsible for any copay or deductibles, as well as any testing not covered by your insurance. The initial examination includes the examination, a retinal drawing, an ultrasound and a pre-operative floater photograph. These charges are normally submitted to your insurance company if we participate with them.

The YAG Laser procedure cost is not covered by medical insurance, please call for pricing and details at 267-594-4002.

Payment: We request payment at the time of service for the laser fee even though you may have insurance.  At our office you will be asked to sign a form that states the patient is responsible for the laser fee payment. We do this because many insurance companies are not familiar with this procedure and the judgement, expertise, skill and time needed for a successful result. Unfortunately because this treatment is so new and so few doctors perform the laser procedure, insurance companies list it as “investigational and experimental” and therefore the cost of the laser treatment is not covered. Also, this is a non-standard procedure, meaning there is no listed procedure code that describes is. Thus, the procedure code used is 67299-58 ("unlisted posterior segment ophthalmology procedure").  Because reimbursement is so variable from insurance companies (some reimbursing well, others poorly, or not at all), we collect payment at the time of the procedure.  As previously stated, the other fees (the examination, extended retinal examination, ultrasound and photographs we submit to the insurance companies, if we participate with them.

How can you submit a claim for reimbursement of the laser fee? After you have the procedure, we will supply you with documents that you can submit to your insurance company that give you the best chance of their reimbursing you for the laser fee.  We supply you with (a) a cover letter to your insurance company; (b) a document that will have Dr. Lavrich's National Provider Number (NPI), her Federal Employer Identification number, the diagnosis and treatment codes, dates of your treatments, the charges and mount you paid; (c) your operation report; (d) a letter of detailed information on the procedure, the medical necessity for the procedure, and the insurance coding; and (e) a copy of the document you signed stating you are responsible for the procedure fee.

Call our offices to see if we participate with your insurance! 267-594-4002

**If you are coming from a long distance, Dr. Lavrich will do a phone consultation to see if you qualify before you come here for your initial appointment.