Insurance Coverage

Raymond E. Peters, Master Ocularist

Out of Network Referrals

Most insurance companies have In-Network and Out-of-Network benefits, thus paying a percentage of their allowed amount and the patient paying the remainder; e.g, 80% / 20% or 70% / 30%, etc. Since this is a rare specialty, most companies do not have a "participating provider" within the area for the patient to have a prosthesis fabricated; therefore, we issue the Insurance companies a letter and ask for an "In-Network Gap Exception/Waiver"; in other words, request that they accept our company for in-network benefits for the patient, so the Insurance Company will pay the higher percentage, and therefore, the patient is paying a lower percentage as the co-insurance. Sometimes a company will ask for us to "negotiate" the fee they will pay, asking us to discount our fee.

At all times, we will be pro-active for the patients in order that they receive the highest benefit, because they are the ones paying the premiums every month. You may contact our offices at 1-888-770-6049 for additional information. In addition, if you complete the insurance questionnaire, Susan will be able to help you with your insurance.

In most cases we will offer the same rate as the contracted provider. I would ask you to call or e-mail us if you have any questions or need any assistance in getting your prosthesis made through my facility.

I have arrangements with the Trianon Hotel in Bonita Springs, which is a four star hotel, to put you there, while this work is being completed and I will pick up the fees for this hotel.

One day fittings are available, but I don't recommend a one day fitting. I like the long cure which ends up being a better prosthesis. So please feel free to call us if you have any questions.