This notice also applies to the following family members under the age of 18:

Privacy Policy

In the course of providing service to you, we create, receive, and store health information that identifies you. It is often
necessary to use and disclose this health information in order to treat you, to obtain payment for services from insurance, and
to conduct healthcare operations involving our office. The Privacy Policy describes these uses and disclosures in detail.

 

I acknowledge that I have been offered and/or received a copy of the Privacy Policy from Lum Optometry.

Cancellation Policy

If for any reason you are unable to keep your appointment, please contact our office 48 hours in advance. Evening and Saturday appointments are the most requested, therefore if you are unable to keep your appointment, we would appreciate an advanced notice so we can offer that time to other patients. Please be aware that appointments canceled within 48 hours may be assessed a cancellation fee. You may be asked to put a credit card on file if you have missed previous appointments.

Contact Lens Fees

Applies only to patients who wear contact lenses. Contact lens evaluation services are not an included part of an eye health evaluation and vision assessment, and additional fees apply. If you have contact lens coverage, you may elect to use your insurance allowance toward the purchase of contact lenses in lieu of glasses. Fees are customized according to the complexity of the case and the predicted time necessary to care for the individual patient. Fees for contact lens evaluation services range between $60 and $130. As with glasses, contact lens materials are an additional fee.

Refraction Fee

If you have routine vision benefits such as VSP, EyeMed, or MES, your insurance will cover a yearly refraction. Refraction is the part of your evaluation that determines your prescription. Refraction is also performed under certain circumstances for diagnostic purposes. Medical insurances that do not include routine vision benefits may not cover a refraction. You may elect to have additional refractions performed outside of insurance coverage. The fee for refraction is $65.

Eligiblity and Financial Liability

Eligibility for medical insurance and/or routine vision benefits. 

We will attempt to verify your plan eligibility for services and/or materials before your appointment. Verification of eligibility is done as a courtesy only and is not a guarantee of payment. Please check with your plan administrator if you have any questions regarding your eligibility. Lum Optometry does not participate in any HMO plans.

Liability

If I have medical insurance or routine vision benefits, I authorize my plan carrier to directly pay Lum Optometry. I also authorize Lum Optometry to release any information required for payment to be made. In the event my plan carrier does not pay, or only partially pays, I understand I am responsible for payment in full or the remaining balance.