POLICY FOR MEDICAL VISITS
Medical visits include examination and treatment for infections, injuries, allergies, headache, eye pain, diabetic eye care and eye disturbances other than Routine eye exams, eyeglasses and contact lenses.
Medical visits and medical insurance coverage are separate from optical coverage. Medical visits are covered by outpatient medical insurance, the same as visits to a family doctor. These visits are not optical, and should be covered regardless of whether the insurance includes optical coverage, which may allow an eye exam every one or two years.
If you see Dr. White for a medical visit, our staff will gladly file a claim with your insurance carrier. There is no charge for the initial filing. However, if it is necessary to re-file, or file with a second insurance carrier, there is a charge of $5 for each additional filing.
IF THE INSURANCE CARRIER, FOR ANY REASON, HAS NOT PAID THE CHARGES WITHIN 60 DAYS FROM THE DATE OF SERVICE, THE CHARGES ARE DUE FROM THE PATIENT OR GUARDIAN.
THE CHARGES ARE YOUR RESPONSIBILITY. IF THERE IS A PROBLEM WITH YOUR INSURANCE, YOU MUST PAY THE CHARGES AND PURSUE THE PROBLEM WITH THE INSURANCE CARRIER. IT IS SIMPLY IMPOSSIBLE FOR US TO PURSUE THESE MATTERS WITH INSURANCE COMPANIES.
If you have no medical insurance, and cannot afford to pay, you must notify Dr. White, or his staff before the services are rendered. Every attempt will be made to provide the services needed. If we are not notified before services are rendered, we will pursue collection of charges.
If for any reason you are sent to a collection agency, an additional 30% late charge will be added to your account balance for late fees.
I have read and agree to the terms stated above. I agree to pay any charges not paid by the insurance carrier within 60 days, regardless of the reason the insurance carrier does not pay promptly.