Insurance

Eye Specialists of Mid Florida accepts most insurance and vision plans. We also participate with many Provider Networks.

When you call for an appointment please have your insurance card available. Some of the information that is required by our appointment schedulers will only be found on your insurance card. We will also ask to see your card at the time you check in for your appointment. We do this not to inconvenience our patients but to confirm their insurance and help their visit move as smoothly as possible.

There are many different insurance plans that are offered and we continue to add new insurance plans on a regular basis, therefore the most accurate way to find out if we accept your insurance plan is to call our office at (863) 294-3504. For additional information, please read below.

Insurance Information Details

Eye Specialists of Mid-Florida is providing this information to help answer any questions you may have concerning our billing practices and insurance procedures. We are always willing to discuss any financial matters with you and assist in any special arrangements should the need arise. Eye Specialists of Mid Florida, P.A. (ESMF) believes that the most important issue is that you receive the best and most appropriate eye care. Many of the eye diseases seen in our clinic can cause permanent visual impairment unless treated promptly. Our foremost concern is the health of your eyes.

Medicare
ESMF participates (i.e., accepts assignment) with the Medicare program. What this means is our staff will prepare and submit your claims directly to Medicare on your behalf. We are reimbursed directly at 80% of the established Medicare fee schedule. You will then be responsible for the remaining 20%, plus any annual deductibles that have not been satisfied. If you have supplemental insurance, it will be filed automatically after Medicare has paid. If your supplemental insurance has not paid after one month, the balance due on your account will be your responsibility.

Medicare Advantage
If you have enrolled in a Medicare HMO or a Medicare Replacement Plan, we will communicate directly with the carrier on your behalf in accordance with the network guidelines. However, you may be required to obtain referral forms prior to your visit. The Medicare Advantage plans are required to provide the same benefits as traditional Medicare, however, it has been our experience at times to have payments either delayed or refused for certain procedures, e.g., iStent. We have found it necessary to request a signed acknowledgement from our patients and request a refundable deposit for services rendered.

Managed Care (HMO, PPO, etc.)
ESMF participates with many prepaid health plans. Due to the ever changing number of plans available, we are unable to list all of them on this site, however, feel free to ask a staff member if we participate with a specific provider or contact your health plan provider directly. ESMF and Eye Surgery and Laser Center (ESLC) (the ambulatory surgery center where we provide surgical services) are separate providers; consequently they may have different agreements with various health plans. ESMF and ESLC make every effort to contract with the same providers; however, we cannot guarantee this will always be the case.

Please read all the literature provided by your health plan regarding patient responsibilities. Some health plans require you to obtain a referral authorization form before we can provide services. Most plans require a copay and/or deductible payment to be made at the time of service. We are contractually obligated to collect your copay prior to your visit with the doctor. If you are undergoing a procedure, your insurance company may require that you pay two copays, one for the doctor’s service and one for the surgery center or supplies. We do not have any control over this policy.

Private Insurance
As a courtesy, ESMF will prepare and submit insurance claims on your behalf for the services provided. Please be aware that you are ultimately responsible for your account as we may not have a contractual relationship with your insurance carrier. If ESMF has not received a payment or determination from your insurance carrier within six weeks, you will be responsible for payment.

No Insurance
Our policy is to provide quality care to all of our patients. We do understand the financial problems that many families face today. In some cases, we are able to assist in obtaining alternative financing through charitable organizations or provide information on other available programs.

Billing Procedure
Like many other businesses, we encourage payment at the time of service. Payment for medical care differs somewhat in that with insurance coverage it becomes the primary payer for a large portion of the services provided. The balance due, depending on your coverage, is your personal responsibility and we will expect payment at the time of service. In the rare circumstance that we must send you a bill, there will be a $20 billing fee added to the account. If there is a problem or if you have questions with regard to the care you received, please contact us immediately.

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Winter Haven Location

Winter Haven

407 Ave K SE
Winter Haven, FL 33880
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Sebring Location

Sebring

5032 U.S. Highway 27 N Sebring, FL 33870
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Clermont Location

Clermont

1050 US Highway 27 Suite 1 Clermont, FL 34714s
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Haines City Location

Haines City

100 Patterson Road Haines City, FL 33844
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Lake Wales

Lake Wales

2800 A Ridgeway Suite 100 Lake Wales, FL 33859
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Lakeland

Lakeland Edgewood

2025 East Edgewood Drive Lakeland, FL 33803
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Lakeland

Lakeland Highlands

2004 CR 540-A Lakeland, FL 33813
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Winter Haven

Winter Haven

407 Ave K SE
Winter Haven, FL 33880
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Sebring

Sebring

5032 U.S. Highway 27 N Sebring, FL 33870
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Clermont

Clermont

1050 US Highway 27 Suite 1 Clermont, FL 34714
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Haines City

Haines City

100 Patterson Road Haines City, FL 33844
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Lakes Wales

Lake Wales

2800 A Ridgeway Suite 100 Lake Wales, FL 33859
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Lakeland

Lakeland Edgewood

2025 East Edgewood Drive Lakeland, FL 33803
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Lakeland

Lakeland Highlands

2004 CR 540-A Lakeland, FL 33813
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