Insurance
A Thoughtful Approach to The Endoret System
Over the past several years, new federal healthcare initiatives have added administrative requirements and onerous restrictions on practicing medicine. As they now exist, commercial insurance and Medicare are no longer compatible with our low-volume, sub-specialty practice with extended patient visits and a personalized medicine approach. While commercial insurance and Medicare may work for high-volume, fast-paced, large group practices, they are unsustainable for us at FishmanVision.
FishmanVision is an “out-of-network” provider with all commercial insurance companies (and vision plans) and opted out of Medicare insurance. The change to a private pay model allows us to expand services and treatment options that are currently limited by commercial insurance and Medicare. We will continue to add the most advanced ocular diagnostics and comprehensive ophthalmic care to our practice.
We hope very much that you will give us the opportunity to take care of you. On the other hand, we understand if this is not possible for you. If you are an existing patient, we will not disrupt your care and will facilitate transfer of care to another group if necessary. We understand the effects of this practice model on some of our patients. If you have additional questions, please do not hesitate to call the office (650-322-4393) or email Dr. Fishman personally.
Thank you for the privilege of caring for you.
Protections Against Surprise Medical Bills (No Surprises Act)
The No Surprises Act takes effect on January 1, 2022 and provides patients financial protections against surprise medical bills, and prohibits balance billing for certain out-of-network (OON) care.
Individuals with Medicare, Medicare Advantage, Medicaid/MediCal, Indian Health Services, VA health care, or TRICARE insurance plans are not covered under the No Surprises Act because these federal insurance programs have existing protections in place to minimize large, unforeseen bills.
All Patients will be receive A Good Faith Estimate for Self-Pay or Uninsured Patients
All Patients will be given a Surprise Billing Protection Form
FishmanVision will provide patients with a scheduled appointment an out-of-network provider Surprise Billing Protection Form. This form contains a Good Faith Estimate of charges for the service requested, a clear statement that consent is optional, and by signing the form, the patient agrees to pay more for out-of-network care.
Consumer Protection Disclosure
In addition, FishmanVision provides patients with a Consumer Protection Disclosure that includes information in clear and understandable language which explains:
- When there are bans on balance billing
- Any state laws that protect you from balance billing
- What state or federal agency to contact if you think your provider or hospital has not followed the bans on balance billing
- Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate (“Good Faith Estimate”) of the bill for medical items and services
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