Please let us know if there have been any changes in the following information
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We are proud to introduce the latest in retinal imaging, the Optomap. It is painless, quick
and the doctor’s preferred method of monitoring the health of your eye. This instrument will
enhance our ability to detect and monitor retinal defects associated with common systemic
diseases such as hypertension, diabetes, high cholesterol, and thyroid problems. Through this
digital imaging of the retina, we can observe early changes in the eye relating to glaucoma,
cataracts, and macular degeneration. Optomap can detect debilitating or potentially fatal
disorders that can be present in the retina.
This technology can be used without dilation, and will be a permanent part of your medical
records. There are no side effects with this test.
By the time you have symptoms affecting your vision, it is typically too late to prevent
permanent sight damage. We care about your vision and want to be sure we actively
monitor your eye; the optomap retinal image is the best way to do this.
There is a nominal fee of $39 to perform this procedure. This includes dilation if the doctor
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Medical vs. Vision insurance explanation
Most people have vision insurance and medical insurance. They are very different in terms of the
services they cover and it is important for our patients to understand those differences. Vision coverage (VSP,
Spectera, EyeMed, Davis, ect….) is mainly designed to determine a prescription for glasses and is not
equipped to deal with complex medical conditions and/or diagnosis. It does allow for screenings of
conditions, but once they are determined, then medical insurance is filed on those services. When a medical
condition is present (such as diabetes, cataracts, dry eye, floaters, etc.) it is necessary to file the visit with your
major medical carrier (BCBS, Aetna, UHC, Cigna, etc.) and the co-pays for that insurance will apply. Insurance
carriers set these rules and our office is required to follow them. In most cases, there is no way to know prior
to the examination which type of insurance our office will be able to file for you.
1. If you have ANY problems or complaints that MAY be attributable to a medical condition which requires a
more in-depth investigation and additional medical decision-making to rule out any underlying eye
disease, we will accordingly bill your MEDICAL insurance, NOT you vision plan. These include, but are not
• New or sudden blurry vision
• Flashes or floaters
• Dry or itchy eyes
• Eyestrain or double vision
• Eye pain or redness
• Loss of vision
2. There are a variety of systemic conditions that can profoundly and permanently affect a patient’s vision
that require a more in-depth investigation, which may include additional testing, follow up visits, and
reports to your primary care physician. This type of examination is NOT covered under “vision” plans,
and we will bill your MEDICAL insurance, NOT your vision plan. These include, but are not limited to:
• Thyroid disease
• Lupus or autoimmune disease
• Diseases resulting in use of high risk
medications like Placquenil
3. If you have previously been diagnosed by another eye doctor for any eye issues that require medical
decision-making, treatment or management, we will bill your MEDICAL insurance, NOT your vision plan.
These include, but are not limited to:
• Amblyopic/lazy eye
• Glaucoma/previous diagnosis of high eye
• Macular or retinal disease
• History of eye surgery
We make every effort to be on every major carrier for your convenience and we will file those claims for
you. In the event that we do not take you insurance we will provide you with an itemized receipt so that you
may file with your carrier for reimbursement. If you have any question, please let us know.
I understand the document above and authorize Dr. Lee and Accurate Family Vision Pllc. to file my
insurance by the above guideline.
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No Show Policy
We understand that situations may arise in which you will need to cancel or reschedule your
appointment. However, each time a patient misses an appointment without providing the proper
notice, another patient is prevented from receiving care. Therefore, any patient who fails to
arrive for a scheduled appointment without canceling or rescheduling the appointment 24 hours
prior to the scheduled appointment time is considered a No Show.
Patients who No Show 3 or more times in a 12 month period will be charged a non-refundable
$50 fee. No Show fees are the responsibility of the patient or guardian and must be paid in full
before a new appointment will be scheduled.
We appreciate your understanding and cooperation.