Financial Policy for TrueVision Eye Care OD PA
Presentation of your health insurance card at each visit: It is necessary for us to verify your demographic and insurance information at each visit. You must present your card at each visit. Inaccurate information prevents us from billing your insurance and results in much wasted effort by our billing staff. Therefore, if you forget your insurance card or we are unable to verify your coverage, it may be necessary to reschedule your appointment or pay in full at the time of service.
Payment at the time of service: Like most businesses, we expect payment at the time services are rendered. If you have health or vision insurance, or a high deductible policy, you are expected to pay your copay and/or deductible amount the day of service. If you know you are not able to pay your copay/deductible we may reschedule your appointment until fees can be collected. Unless your care is included in a global period such as Cataract postop, Lasik postop, or Contact Lens fitting a charge will be incurred for each appointment with the doctor. We will file applicable insurance claims. For your convenience, we accept cash, check, credit card, or care credit. If you would like to apply for care credit, one of our staff members would be happy to assist you with your application. Any custody situations are a private matter between the parents and not the responsibility of Truevision Eye Care. The parent/guardian that brings a child in for treatment is the one responsible that day for any payments due.
Vision Plans: Vision plans only reimburse for wellness eye exams and routine eye diagnoses. These can be thought of as examinations for vision anomalies to prescribe eyeglasses. Vision plans do not cover evaluation and treatment for medical conditions such as Diabetes, Glaucoma or medical complaints such as red eyes, headaches, itchy eyes. Any eye exam due to a medical complaint and/or resulting in medical treatment cannot be billed to a vision plan. Any diagnostic or treatment procedures which are not covered by your vision plan, or your medical plan must be paid for by you or will be billed to your medical insurance. If you have any questions regarding which insurance will be used for your visit, please ask our front desk staff for clarification.
Patient Statements: We make every effort to verify your benefits but are not always given real time information by your insurance company. In the case of insurance denials, we will contact the insurance company to verify that the claim was processed accurately and, if so, you will be billed within one week and on the first of each month thereafter. Your statement balance will be due on receipt. To avoid misunderstanding, it is important that you contact our office at (919) 4724070 with any concerns about your balance and notify us if you change your address and or phone number.
Collections: All patient balances that remain delinquent after 90 days, with no response to our requests for payment, may be referred to a collection agency. Should it become necessary to turn your account over to a collection agency, a collection fee of $30 will be added to your balance
Checks: A returned check fee of $30 will be added to your balance if a check is returned to us by your bank.
Eyeglasses: All sales of prescription and nonprescription eyeglasses and sunglasses are final. If there are any discrepancies between the Doctor’s prescription and the lenses manufactured by the lab, or you have problems adjusting to your new prescription, any changes to the prescription lenses are included at no charge within 60 days. If you are fit in a progressive lens and cannot adapt we will remake the lenses at no charge into a single vision distance, near or lined bifocal. No refunds will be given. All orders require a minimum 50% deposit. Adjustments for glasses and minor repairs purchased at TrueVision Eye Care are provided free of charge. Professional services are nonrefundable. All namebrand eyeglass frames are under manufacturer warranty for any manufacturing defects for up to one year from the date of purchase. We do offer the option to buy a warranty beyond the manufacturers warranty to cover accidental damage or breakage to your eyeglasses.
By signing this form, I agree that I have read the financial policy and agree to the terms. I agree for all payments from my insurance carrier to be made directly to TrueVision Eye Care OD PA. I certify that the information I reported with regard to my insurance coverage is correct. TrueVision Eye Care may share the results of today’s examination with my insurance company, if necessary, to ensure proper processing of the claim.
Contact Lens Services
A contact lens examination requires additional testing beyond what is included in an eye examination. While most insurance plans do not cover the cost of contact lens services, some plans offer a discount or limited coverage that may cover part of the fees. Fees quoted over the telephone and before the exam are only estimates. Before the contact lens examination is performed, we will inform you of the amount due for the exam for your particular prescription. Fees range between $80-$200.
Patient Name ______________________________________
Patient/Guardian Signature ______________________________ Date _____________
Please print out our form to sign and bring into the office at your next appointment.