It is important that you carefully review our policies and speak to the staff before signing if you have questions!
All doctor's fees are due the same day the services are rendered. This means you must have the ability to pay these charges before you are examined. We will not bill you, or any other individual, for these services. Your insurance may pay a portion, or all of your doctor's fees, but you are directly responsible TODAY for all fees your insurance doesn't pay (such as co-pays and deductibles You may be asked to show proof that you've met your deductibles.
Our lab requires a 50% deposit on eyewear before we are able to order these items for you. The balance is due upon delivery. Contact lenses may be paid for upon delivery (custom lenses must be prepaid We are happy to accept most vision insurance benefits in lieu of payment. Be sure you check with our staff to make absolutely sure we accept your vision plan (do not assume we do You must pay the difference in your insurance coverage and the cost of your eyewear or contact lenses before delivery.
You must provide us with information regarding your insurance coverage. This includes your insurance card (opposite page In some cases we may require that you verify your coverage and specific benefits by providing us with a benefits page or booklet from your employer or insurance company (this is sometimes the only way we can verify your coverage If you are unaware of your coverage, benefits, copay or deductible status you may be asked to pay your fees today (aportion or the entire amount We may require an EOB (explanation of benefits) to verify your deductible status on certain insurance plans.
YOU are responsible for payment of your bill should there be a dispute about your claim with your insurance. If collection of your account becomes necessary, we will add the cost of collection to your account.
We also accept VISA, MasterCard. Discover and American Express.
There will be a $40 returned check charge for each returned check.
If you have read, and understood the above information, please sign below (once per date You cannot be seen without signing. If you are under 18, your parent or guardian must sign for you.