Medicare and Medicaid coverage: Artificial eyes and related services are a covered procedure under Medicare and Medicaid guidelines. However, a request from your ophthalmologist is required prior to your fitting, . This request can be in the form of a written prescription from your ophthalmologist or a letter requesting this service.
Medicare pays 80% of their allowed amount based on what part of the country you live. If you have a Medicare supplement, it pays the additional 20%. This office requires Medicare patients to cover their professional service at the time they are provided. Our fee is due upon the first visit. We do not accept assignment for Medicare patients, however, we will complete all billing information for you, as well as have your insurance reimbursement sent directly to your place of residency.
Medicaid claims are accepted with a physician's written order; the patient should have no co-pay or deductible unless they are on a "share-of-cost" plan. Colorado state law requires authorization to be presented prior to scheduling your appointment.
Private Insurance: Most insurance companies will pay at least a portion of the fitting and supply fees for your artificial eye. Prosthetic devices are categorized by insurance companies as Durable Medical Equipment, or DME; as such, most insurers will pay 80% of their company's allowed amount. This allowed amount varies from company to company.
The Denver Optic Company will help you to secure the highest level of coverage for each case, but don't assume the complete cost will be covered by your insurance.
PLEASE NOTE: In some cases, the Denver Optic Company is contracted by specific insurance companies to accept assignment on claims. This is also true when utilizing worker's compensation benefits, automobile insurance, and services covered by the Veteran's Administration, Victim's Compensation, and Vocational Rehabilitation Services. Please contact our office should you wish to confirm eligibility.
