Brighton Eye Care
75 Leighton Rd.
Falmouth, ME. 04105
Thank you for choosing Brighton Eye Care for your eye health needs. Please be assured that we wish to
offer you the complete and excellent care that you deserve. In order to provide you with the best care,
we would like to take a moment to explain the difference between a routine eye exam and an annual
medical eye exam. Below you will also find our billing and insurance guidelines.
A routine eye exam consists of an eye health screening and refraction. During a routine eye exam your
doctor may choose to dilate your pupils. Dilating your pupils permits your doctor a thorough
examination of your retina and other deep structures of the eye. The refraction portion of your exam is
how you and your doctor determine your final eye glass prescription. If during your eye health
screening, your doctor detects something, you may be asked to have some other, more specific, tests
done. These other tests are not part of a routine eye exam, and cannot be billed as such. These tests
will be billed to your medical insurance. Schedule and insurance permitting, they will be ordered for the
same day. Some insurance companies require these tests be done on a separate day, because of this
you may be asked to come in at another time to have them done.
An annual medical eye exam is performed on patients with a known eye or medical condition. Some
common conditions that would warrant a medical eye exam are cataracts, glaucoma, diabetes, dry eye,
to name a few. These exams, along with any testing, are billed to your medical insurance. How we bill
insurance is explained below.
If you have any questions or concerns about what you need to be seen for or what type of appointment
is appropriate for you, please call our office and we will be happy to help you. Our receptionists are
available to schedule your appointment, along with any tests, as far in advance as one year.
Billing and Insurance Guidelines
The providers at Brighton Eye Care participate with most major insurance plans in the State of Maine.
These plans include managed care plans, Medicare, and Vision Service Plan (VSP).
We understand that insurance policies and procedures can be confusing at times to our patients. Our
billing office will submit bills to insurance companies with whom we participate through contractual
agreements. We do not bill insurance companies that do not have a contract with this office.
If you belong to a non-participating insurance company, or do not have insurance coverage, we will ask
you to pay at the time of your visit. We accept cash, personal checks, debit cards (with a Visa or
MasterCard logo), Discover, MasterCard, and Visa. If you have any questions concerning our
participation with your insurance company please give us or your insurance company a call prior to your
visit.
Routine eye exams are covered by Vision care plans (VSP) and, in some cases, by a routine benefit
through your health insurance. A routine eye exam is a screening for eye disease along with a refraction
which determines your eyeglass prescription. Routine eye exams do not cover diagnosis, management
or treatment of eye diseases, nor do they cover any specific testing.
Medical insurance must be used if you have any eye health problem or systemic health problem that has
ocular complications. Your doctor will determine if these conditions apply to you, however some are
determined by your case history. In some cases your doctor will recommend special testing, based upon
your specific needs. You may be asked to obtain a referral from your primary care physician. Most of
the time a medical insurance plan will cover these tests but they may be applied toward your annual
deductible and/or your health plans coinsurance. Please verify with your insurance company to see if
these costs apply to your plan.
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Co-pay: The set amount you pay for each health care visit. Your co-pay does not apply toward
your deductible.
Deductible: The amount you pay before your health plan begins to pay for covered services.
Coinsurance: The coinsurance applies after your deductible has been paid. This is a percentage
of your health care costs that you are responsible for.