Office Policies and Patient Financial Responsibilities

Payment: You are responsible for any co pays, co-insurance, deductible, and other non-covered services. Any surcharges for spectacle upgrades set by your vision insurance must be paid at the time of service before any orders will be processed. If you are a self pay patient and/or your insurance cannot be verified prior to your appointment, you will be required to pay in full the day services are rendered.
We accept cash, personal checks, all major credit cards, and Care Credit. If you are being seen for any ongoing medical problems, co-pays are due at each and every visit. If you foresee any payment problems, please speak to our office staff prior to your appointment.

Claims Filing:
As a courtesy to our patients, we will file medical claims with medical insurance companies for which we are providers. We will do our best to accurately verify benefits for services and/or materials, however, benefits quoted by your insurance carrier are not a guarantee of payment. Should your insurance deny a claim for any reason, you will be responsible for any remaining balances as directed by your insurance.

Patients that receive a statement from our office are expected to remit full payment upon receipt unless previous payment arrangements were made with our billing office. If you account must be referred to an outside collection agency for non-payment, a fee will be added to your account to cover the expense incurred form the agency. Patients in collections must make payment arrangements prior to scheduling another appointment with our office. If you receive a billing statement that you do not understand, please contact our office.

Proof of Insurance:
We are required by law to get an up-to-date copy of your insurance card(s) before you see the eye doctor. If you do not present this at the time of your visit or fail to provide us with the correct insurance information, you will be responsible for the balance of the claim.

Secondary Insurance:
If you have secondary medical insurance, it is your responsibility to have them set up to crossover to each other. Any balance that does not automatically crossover to your secondary insurance will be your responsibility. We will provide you with an itemized receipt that you can send with a copy of your explanation of benefits that you received form your primary insurance for possible reimbursement.

Non-Payment:
If we do not receive payment from your insurance company within 60 days, the balance will automatically be billed to you. If your account is over 90 days past due, you will receive a letter stating that you have 21 days to pay your account in full. Partial payments will not be accepted unless previously discussed. Please be aware that if a balance remains unpaid, we may refer your account to a collection agency. If this is to occur, you will be notified by regular and certified mail that you have 30 days to find alternative eye care. During that 30 day period, our office will only be able to treat you on an emergency basis.

Missed Appointments:
Once your appointment has been confirmed it will be reserved for you to meet your eye care needs. Please be courteous to our staff and fellow patients by keeping your confirmed appointment. If you are unable to keep your scheduled appointment, please inform us as soon as possible. We do require a 24 hour notice of cancellation of your scheduled appointment. A minimum fee of $50.00 may be charged to your account for broken appointments based on the amount of time and service reserved for you. If you do not cancel 24 hours in advance or no-show for your scheduled appointment 3 times in a 12 month period, we have the right to dismiss you from our care.

I authorized Vision Advancement Center, PLLC and Advanced Vision Therapy, PLLC to act as my agent in applying for insurance and/or Medicare benefits, and I authorize payment of these benefits directly to Vision Advancement Center, PLLC and Advanced Vision Therapy, PLLC on my behalf. I authorize any holder of medical information about me to release information needed to determine benefits payable for related services. If I have additional insurance, my signature authorized release of the above medical information to any insurer or agency I have given, and authorize my doctor to act as my agent above.