Insurance, Policies, and Procedures
There are two types of Insurance that may contribute to services performed today. Vision Insurance (VSP, Eyemed, Davis Vision, ETC. ), and Medical Insurance (BCBS, UHC, Select Health, ETC.) You may have one or both.
Vision Insurances cover routine wellness exams and hardware (contact lenses or glasses). They do not cover the diagnosis, treatment, or management of eye health problems.
A contact lens fit is considered elective and your Insurance will not cover that portion of the exam.
Medical Insurance can be used to help with management of medical eye care.
We will gladly bill one or both of your Insurances to help minimize your out of pocket expense.
If some fees are not paid by either Insurance you will be billed for those appropriate fees, such as co-pays or deductibles as per your Insurance plan.
We must have a copy of all insurance cards in order for services to be billed.
Authorization for Treatment and Financial Agreement
I authorize treatment for the above named person and agree to pay all fees and charges for such treatment. I agree to pay all charges shown on statements promptly upon presentment thereof, unless credit arrangements are agreed upon in writing. Charges shown on statements are agreed to be correct and reasonable unless protested within thirty days of billing date. Our staff will help with completetion of insurance forms as an accommodation and convenience to you without charge. IT IS THE PATIENT'S RESPONSIBILITY TO KNOW YOUR CONTRACT BENEFITS, ASSURE COLLECTION OF INSURANCE PAYMENTS TO US, AND TO NEGOTIATE WITH YOUR INSURANCE COMPANY OVER ANY DISPUTED CLAIMS. It is agreed that payments will be delayed or withheld because of any insurance coverage or the pendency of claims thereon, and all proceeds of insurance are assigned to this office where applicable, but without assuming responsibility for the collection thereof. All account balances thirty days or older will be subject to a finance charge of 1.5% per month (annual rate of 18%). A charge of $25.00 will be assessed to all returned checks. Should collection become necessary, the responsible party agrees to pay a collection fee of up to 40% and all legal fees of collection, with or without suit, including attorney fees and court costs.