Insurance and Medicare Notices

These are some notices we have posted in our waiting room to inform our patients of changes and requirements having to do with Insurance coverage and Medicare

Insurance coverage change:
Medicare and some Private Carriers will no longer pay for injections of Testosterone, Thiamine and B12

New Prescriptions and Prescription Refills:
For all prescriptions and refill requests that require preauthorization, you will be asked to schedule a visit with a nurse practitioner before it can be filled.
This will be to discuss the medications and complete the required forms that only a medical provider can perform.

Medicare D Prescription Plan
The Medicare D Prescription Plan prefers generic substitutes whenever possible. There are very few, if any situations where brand only is required. We cannot provide information for “brand only” prescriptions unless there is a legitimate medical necessity.
If you require or want the brand name drug, Medicare may not pay for it and you may be asked to pay full price for it at the pharmacy when picking it up.
This also means we will not be able to dispense physician samples of a brand name drug, if you are taking a generic substitute.
Thank you for understanding.
Medicare Prescription Drug Plan Information Line: 1-800-633-4227.

Preferred/Participating Provider Change
We are no longer a Preferred/Participating provider with Healthcare Networks of America. If your plan is administered by this network, be advised that services provided by our facility will be considered out-of-network and will be paid/processed at lower benefit payments or not at all.

Referrals and Insurance Coverage
We cannot guaranty insurance coverage when referring outside of our facility.
When being referred to hospitals, diagnostic centers and other physicians, it is the responsibility of the patient to check with their insurance plan to verify that those services are covered under their particular plan.
Information shared by us, The Light Clinic PC, is general and in no way serves as a guaranty of coverage due to plan variations of coverage.

Lab One Patients
It is your responsibility to notify our Lab that your labwork needs to be sent to the Lab One Laboratory

Routine Physical Exams
If you wish your exam to be billed as a routine physical, let the Front Desk know.
Note- your Insurance may not cover a routine physical, or may have a limit which will not cover the entire cost.
Our office will not be responsible for rebilling of claim services if you did not provide us with the proper claim billing information.

Prostatic Specific Antigen Test
Medicare will pay for one PSA test (critical in the diagnosing of Prostatic Cancer) per calendar year.
Other plans may not cover this test unless it is medically necessary, and payment will be the responsibility of the patient.