EyeMed

And for our last example, we will take a look at our EyeMed benefits and eligibility. 

To retrieve benefits and eligibility information you will go to the Eyemed website which is claims.eyemedvisioncare.com. Once you have logged in with your provider username and password, you will come to the members search page. You can see the navigation bar on the left here.  

Now you can either do a name search, you can search by member ID. You also have the option to search by social security number or zip code. If you're looking for a specific plan through Aetna or Blue Shield California, you would want to select each of those, depending on which one you're looking for. Now I typically like to do your patient's name, date of birth, and date of service search. No matter which route you choose though, always make sure, once again that you're pulling up the correct patient information, so verify all of your patient information is correct and that your information matches your practice management software as well.  

When we’re looking at our member details, we will also see the network and group We also have a benefit level here as well. Service eligibility is just an explanation of what you are looking for.    

As we look here, we see that our patient is eligible for all services. And it also tells you the eligibility as of date and service frequency. To authorize benefits, you would select whichever benefit you needed to authorize. As you scroll down the page, you will see a benefits summary and it shows that an exam under the age of 18 is a $0 copay, then it will describe your contact lens fitting benefits, which in this case is a $55 or up to a $55 copay for a standard fit and follow-up or premium visit. It also shows this patient would receive 10% off of the retail or your usual and customary fee. After that, you will notice frame benefits, as well as lens co-pays, and any add on options that may be available. You will see listed either a copay, or a discount in this situation, a 20% off retail price or whatever the benefit may be of course. 

Now the benefits are typically frame and lenses or contact lenses with most of your EyeMed plans, and I believe you still get the frame benefit, even if you use the contact lens benefit. Always look at the specifics as far as each of your individual plans go. Next, you will see your contact lens benefits that are available for your patient and any additional purchases as far as a discount that you would be able to give to your patient. It's pretty easy as far as searching for patient benefits and generally you are going to log into whichever website or call whichever insurance company you're needing benefits for. You would give them their patient information as well as date of birth and ID number and always search for patient benefits before the patient comes in or prior to providing services and materials.