Rebuck & Associates Eye Care - Office Policies
We want you to enjoy your visit with us and you should know that by being examined at our office, you agree to the following policies:
1. If you want your examination to be billed to any type of coverage, then you must present your medical insurance and vision plan cards before we will treat you. If you do not, then we won't bill your insurance and you will have to pay in full on the date of service. We will not bill you later. If you are unable to pay on the date of service, then you must reschedule, unless it is a true ocular emergency. We do offer financing through Care Credit.
2.Vision plans (Davis, Spectera, VSP, Eyemed, etc only cover healthy eye exams for nearsightedness, farsightedness, astigmatism, and the need for reading glasses. If you have other eye conditions like cataracts, glaucoma, diabetes, red/pink eye, etc., then your vision plan will not be billed and it must be billed through your medical insurance or paid out of pocket. Your vision insurance will not be billed if your medical insurance denies your claim, except for the refraction/glasses testing charge.
3. Glasses testing/refraction (if your examination is medical in nature) and contact lens evaluations are separate procedures, so both have additional and separate fees, which are not covered by some vision plans or medical insurance. If you desire to get a prescription for contact lenses, then you must have a contact lens evaluation. You have the right to decline the refraction or contact lens evaluation, but you will be unable to order glasses or contact lenses without a current prescription. You can't legally order contact lenses from a glasses prescription. If you are being fit with different contact lenses, then you must return in a timely manner so that your follow up visits are completed within 60 days after you receive your first contact lenses. After this period, you must pay for another fitting at full price.
4.Co-pays must be paid on the date of your examination. If you can't pay your co-pay today, then you will have to reschedule. If we can verify that your medical coverage has an unmet deductible, then you will have to pay towards your deductible today and we will submit a claim to your insurance. After receiving the response from your insurance, we will notify you whether you owe any additional fees or
5. All charges incurred are the financial responsibility of the patient, parent, or guardian regardless if the insurance covers any of the fees. Our staff may attempt to explain your benefits, but we are not insurance experts. You are responsible for knowing what your benefits cover, whether you need a referral and for obtaining a referral prior to your examination. We have to rely on insurance company information which may not be updated.
6. Any balances remaining unpaid after 30 days will accrue 1.5% interest per month. Balances over 60 days may be taken to collections or court. You are responsible for all court costs. If you still don't pay, then this can be reported to credit agencies and this may constitute breach of contract, thus enabling cancellation of your insurance coverage.
7. There may be a charge when requesting copies of your medical records and all balances must be paid before this information will be
8. You have a right to your eyeglass prescription and as a patient you will be provided with a copy. Local opticians generally do a good job of filling our prescriptions, but we have some concern with the use of eyeglass vendors over the internet. Fitting eyewear properly involves precise measurements such as PD/pupillary distance and segment height that an internet vendor cannot provide. We provide these measurements at no charge for patients purchasing eyewear from us. If you want these measurements to buy your glasses elsewhere, there will be a $40.00 charge. Payment of this fee entitles you to free adjustments and prescription verification for the glasses.
Assignment and release
I hereby authorize and request that my insurance company pay directly to Rebuck & Associates the amount due in my pending claim for vision or medical treatment or services by reason of such treatment or services.
I further assign to Rebuck & Associates all rights afforded to me under ERISA with respect to the services rendered, including the right to bring an action to enforce ERISA and my ERISA rights.understand that insurance is a private arrangement between me and the insurance company, and that I am fully responsible for all monies due as a result of the services, products, or treatments provided to me by this office. Also, by my signature below, I acknowledge that I received and reviewed a copy of Rebuck & Associates Eye Care, PLLC's Notice of Privacy Practices.
By signing below, I understand that I am financially responsible for all charges whether or not paid by my vision or medical coverage, have been provided the HIPAA privacy policy, Glasses Policies of this office, and approve OCT/Optos testing as prescribed.