Payment, Medical Release Authorization, and Insurance Assignment
All fees paid for professional services are non-refundable and must be paid at the time of service. All insurances must be pre-approved prior to your examination. Sensitive ID information is provided by the patient/guardian for the sole purpose of medical record keeping, insurance verification and claims processing. Patient authorizes that payment of vision and medical insurance be made to Ahren Castro OD PLLC d/b/a Prime Eye Center for services provided. Patient is financially responsible for co-pays and deductibles incurred by the insurance. If the patient is not eligible for insurance benefits or are eligible for less than full coverage, the patient agrees to be financially responsible for any unpaid balance. If it is discovered that the patient has insurance after services are rendered, it is the responsibility of the patient to file his/her own claim for reimbursement. Our office will not back-file claims, post authorize, or refund fees. The patient also acknowledges that certain examinations and examination findings may not fall within the realm of a routine eye exam, and may deem to be medically necessary to file under your medical/health insurance or will need to be referred to another office. The patient also authorizes the release of any medical or other information to process insurance claims.