Thank you for choosing us as your vision provider. We are committed to providing you with the best possible medical care at the lowest possible cost. The following information is to familiarize you with our billing policies:
• Full payment for services is due at the time services are rendered. As a courtesy we will bill your vision or medical insurance. Please Note: Both Vision and Primary Medical Insurance Information is required prior to your visit. Some of the procedures performed as part of your eye exam may be medical procedures which are covered under your medical insurance, not your vision insurance. Your medical plan may require you to pay a co-pay, deductible, or coinsurance at time of service. If you prefer not to have your medical insurance billed, payment will be required at time of service for any medical procedures performed. You will be provided a receipt to obtain reimbursement from your medical insurance company.
• If a referral is required by your policy, it will need to be received prior to your appointment.
• If your vision or medical insurance company was billed and payment is not received within 45 days, the balance will be transferred to the patient’s responsibility and you will be billed. It is the patient’s responsibility to obtain payment from the insurance company or negotiate a settlement on any disputed claim. Any portion of the bill not paid, or denied, by the insurance carrier, will be the patient’s responsibility.
• You must inform our office if you have a new insurance carrier or if the insurance carrier has located to a new address. Please bring your insurance cards with you for your appointment. In the event that your insurance coverage, or our plan participation changes, to a plan where we are not participating providers, you will be responsible for payment of all fees at the time service is rendered.
• We will bill secondary insurance if we are contracted with your secondary insurance carrier. If we are not, we will bill you for the remaining amount due after your primary insurance carrier has paid your claim. If you need to submit to your secondary insurance for reimbursement, use the Explanation of Benefits (EOB) from your primary insurance carrier and the statement of services provided at your visit to bill your secondary insurance.
• Prescribed ophthalmic eyeglass lenses are a medical device, specifically manufactured for the patient which it is prescribed. Once we contract our laboratory to fabricate your prescription eyewear you will not be able to cancel or obtain a refund on your order.
• Upon receipt of payment from your insurance company, you will receive a statement showing your balance due. Payment is expected immediately. For your convenience, we accept most major credit cards. All services provided are eligible to be paid for through your pre-tax medical account if you are a participant.
• In the event your bill is not paid, your remaining balance may be referred to an attorney for collection.
• This office reserves the right to change its fees at any time without prior notice. • A finance charge of 25% will be added to any balance over 90 days.
• A missed appointment fee of $75.00 will be billed for any appointment not cancelled within 24 hours of the appointment time.