Our office requires payment at the time of service unless we "accept assignment" on your insurance. You are responsible if your insurance does not pay. Contact lens fittings are billed separately from your eye exam. I authorize the release of any medical or other information necessary to process this claim. I also request payment of insurance benefits to the party who accepts assignment below. Your information is protected by our privacy policy. I have received a copy of Helfrich Family Eye Care "Notice of Privacy Practices."