I certify that the information I have provided is true and accurate to the best of my knowledge and authorize the release of any necessary information, including medical information, to my insurance company in order to determine insurance benefits. I understand that my insurance company will be billed for services and/or products and I am responsible for any co-pay, deductible and non-covered or denied charges incurred on my account. Any “quote of benefits” does not guarantee payment or verify eligibility. Payment of benefits are subject to all terms, conditions, limitations and exclusion of the member’s insurance contract at time of service. If your insurance company determines that a particular service or product is not a covered benefit, they will deny the charge. We suggest you contact your insurance company before your appointment to confirm whether a prior authorization is needed.
****** A NOTE TO ALL OUR CONTACT LENS WEARERS ******
Contact lenses and any procedures preformed to determine or update contact lens prescriptions are not considered “medically necessary” and may not be covered by insurance, any charge as a result of these procedures will be your responsibility
** No Show Policy** - out of respect to others who want to schedule with our Doctors, not showing for a scheduled appointment will incur a charge of $50