Insurance and Patient Forms


Please bring these items with you to your visit:

  • Patient Forms (completed) *If you filled these out online you do not need to bring any forms
  • Driver’s License/ Photo ID
  • Vision Insurance Card
  • Medical Insurance card-*needed in case of treatment for a medical condition related to your eyes
  • Insurance Subscriber’s name- *if insurance is under your spouse, please provide their name, date of birth, and last 4 digits of their Social Security #

The major Vision care plans we accept:

  • Avesis
  • Eyemed
  • VBA (Vision Benefits of America)
  • VCP- Comp Benefits
  • VSP (Vision Service Plan)
  • Spectera/Optum Health- we will see established patients with this plan through 12/31/2015; however, we are no longer accepting new patients with Spectera/Optum Health

The major Medical insurance plans we accept are:

  • Aetna
  • Anthem *we ARE NOT PROVIDERS for Anthem Pathway PPO or Pathway X Silver, Bronze or Gold
  • Blue Cross/Blue Shield
  • Champus/Tricare
  • Cigna
  • Humana (Not Humana Medicare PPO)
  • Medical Mutual
  • Medicare
  • Ohio Health Span
  • RR Medicare
  • Secure Horizons
  • UMR
  • United Health Care *we DO NOT take UHC Vision


Insurance and Payment Policies

We do our best to Pre-Authorize your insurance benefits prior to your visit. To enable us to do so, please fill out the forms completely and either send electronically or bring them with you to your appointment.

We cannot backdate insurance services. Some insurance companies allow eligibility by calendar year, and some allow eligibility based on your last date of service. If you are not sure, call the member services number on your insurance card.

What credit cards do you accept?
Payment for co-pays are expected at the time of service, and we accept American Express, Discover, Mastercard, Visa. You can use your flexible spending or HSA card to pay for your exam co-pays and glasses or contacts.

Why do I need to provide my medical insurance card ?
We like to have this information on file in the event that we need to see you for a medical reason. Sometimes Dr Fiorenza needs to take a scan or picture of the eye, and that is typically covered by your medical insurance rather than your vision insurance. If you have a medical emergency such as an eye infection, it is also billed to your medical insurance rather than your vision insurance.

What does Vision insurance cover?
Vision insurance covers one annual exam, and usually there is a co-pay of about $10 for this exam and refraction. If you have any of the major Vision plans that we accept (see list above), we will pre-authorize your benefit and be able to show you a complete breakdown of all the covered services and costs for glasses or contacts. Vision insurance also provides discounts on glasses and contacts. Sometimes the plan lets you purchase a new frame every year, sometimes you have to wait two years. We’ll know what your eligibility is with Vision insurance once we pre-authorize the benefit. You can use your benefit for either glasses or contacts, but usually not both. In most cases, we find that you will save the most money by using your benefits towards glasses, and purchasing a 1 year supply of contacts with the manufacturer’s rebate, if one is available.

I have new insurance. How do I know what is covered?
Every insurance card has a member customer service number on it. Please call your provider and ask what is covered for each member of your family. There are hundreds of providers, and thousands of plans available. We know a lot about insurance, but we don’t know everything! If you ever have a question about your bill or how your discounts and co-pays were applied, please ask. It can seem confusing and we’ve been doing this a long time, so we’re happy to explain it!

My insurance provider has Montgomery Vision Care listed on their website as a provider, but it is not on the list above. How do I know if you are a provider?
Give us a call! Just ask us– sometimes insurance companies don’t update their websites, and we may be listed as a provider but we are not. We know which insurance companies we have contracts with and will be able to help you out, even if you’ve never been here before!

Is Optomap Retinal Imaging Covered by Insurance?
No, it is not. The fee is $35 and payment is due on the date of service.

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