COST AND INSURANCE
The charges we make are: examination $245 (code 99244 if consultation referred from another doctor, or code 99204 if self referred); extended retinal examination with drawing $55 (code 92225) for each eye; pre-operative floater photograph $65 (code 92250) for each treated eye; and the laser treatment of eye floaters $1,485 per eye (code 67299-58). This totals $1,905 for the first eye and $1,550 if the second eye is done. You may call our office at (703) 536-2400 to ask about charges.
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 not accept medical assignment from medical insurance companies. We do this because many insurance companies are not familiar with this procedure and the judgment, expertise, skill, and time needed for a successful result. Also, this is a non-standard procedure, meaning there is no listed procedure code that describes it. 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. The other fees (the examination, extended retinal examination, and photographs) we submit to the insurance companies if we participate with them.
The laser fee covers up to four treatments per eye during a three month period. In the great majority of patients we need only two treatments per eye during the initial trip here, and then the case is considered finished. But if the patient has very large floaters or multiple floaters (we discuss this with the patient before starting treatment), three treatments may be given while here. If a patient needs to come back for a third or fourth treatment within three months, that is done without any additional laser fee; however, we charge at that time $200 for the examination ($145 for the regular examination and $55 for the extended retinal examination with drawing (code 92225). After three months the fees are $200 for the examination plus $650 for additional laser treatment if done.
How can you submit a claim for reimbursement of the laser fee? After you have the procedure here, 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. Karickhoff’s National Provider Number (NPI), his Federal Employer Identification number, the diagnosis and treatment codes, dates of your treatments, the charges, and amount 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 (d) a copy of the document you signed stating you are responsible for the procedure fee.
If you would like to know before your appointment here what your insurance company might reimburse you, you do this by attempting to get a pre-approval letter from them. It is your responsibility to contact your insurance company for this. You can download our Medical Necessity Letter below which explains much about the procedure, the fee, and coding, and send that to your insurance company. If it is important to your company, Dr. Karickhoff would be an “Out of Network” provider.(Your attempting to get this pre-approval letter before seeing Dr. Karickhoff is frequently disappointing because the insurance company can deny your request, saying they have insufficient data to make a decision.We can not then supply that information because we have not seen you. Your chances of being given reimbursement from your insurance company is greater after we have done the procedure when we give you a copy of your bill, what you paid, your operation details, and the medical necessity for the procedure.)
If you have no insurance, or, we don’t participate with your insurance (see list below), all charges are paid by you in our office.
If we participate with your insurance, after you pay the co-pay and any deductible, we submit to your insurance company the charges for the examination, the extended retinal examination, and the photograph fee.The insurance companies are familiar with and pay on these fees. However, Medicare does not reimburse for these photographs, but they are essential to show the presence and extent of the floater. With Medicare the patient pays the photographic fee ($65) out of pocket. If there is a difference between what they allow and what they pay, the difference is paid by the patient or secondary insurance. For example, your insurance company may pay 80 per cent of their allowed charge and the patient or secondary insurance pays the remaining 20 per cent. The diagnosis is "vitreous opacities" (code 379.24). Again, we do not submit the laser fee to insurance companies. The patient pays that at the time of service, and we give the patient documents to seek reimbursement.
We participate with the following insurance companies: Cigna (PPO), GEHA, and United Healthcare Group. (United Healthcare Group's PPO's are One Net [Alliance], Choice, Choice Plus, and Mamsi Life. Their HMO's are Select, MD IPA, and Optimum Choice. Referrals are required for MD IPA and Optimum Choice.) We participate with Anthem (Blue Cross Blue Shield of Virginia), First Health Network, Coventry, Mutual of Omaha (AFSPS-American Foreign Service Protective Agency), Aetna (not Aetna/Pioneer), Aetna HMO, Coventry, Mail Handlers, Medicare/Unicare combo, PHCS (Private Health Care System of the Nation Capitol Area), Multi-Plan, Blue Cross-Blue Shield of D.C., Great West, Choice Care Network, Care First BCBS PPO, and Care First of MD.
We prefer cash or major credit cards.
If a referral is necessary for your insurance to pay, obtaining the referral is the responsibility of the patient.
Letter of Medical Necessity