POLICIES & PROCEDURES I understand that while my medical insurance may confirm benefits, confirmation of benefits does not mean that the insurance company will reimburse SCHWARTZ EYE ASSOCIATES and that I am responsible for any unpaid balance.
I understand and agree that it is my responsibility to know if my insurance has any deductible, co-payment, co-insurance, prior authorization requirements or any other type of benefit limitations for the service I receive. I agree to make payment to SCHWARTZ EYE ASSOCIATES in full.
MEDICAL V. VISION INSURANCE Medical Insurance: When a medical condition or diagnosis is present during the examination. Any condition related to the health of your eyes (Diabetes, Cataracts, Dry Eye…) and it is necessary for the doctor to provide you with a comprehensive ocular health evaluation. In this case, we will file a claim to you health insurance carrier. Most carriers will pay a portion of the exam and diagnostic testing necessary to determine, diagnose and treat medical conditions related to your ocular health.
Vision Insurance: Coverage through Eyemed is designed to determine the prescription for glasses or contact lenses ONLY. This does not include a detailed exam of the health of the eye or any diagnostic testing needed to determine medical conditions. If you have any medical condition, use medication that has potential ocular side effects, or any medically related eye condition your medical insurance becomes PRIMARY and Eyemed is secondary. Under no circumstances does vision insurance cover any exams requiring medical treatment of the eye or prescription for medication.
Copayments & Deductibles: Copayments will be collected at the time of service. If you have not met your deductible, we will collect the deductible. Each insurance has a different allowed per service or office visit and we will estimate the insurance allowable and collect that amount. If we overestimate, we will refund you that amount after all the insurance has been cleared. If we underestimate, you will be billed for the balance.
Refraction: Refraction is a procedure incorporated into an ocular exam and used to determine your best possible visual acuity. It is considered a NON-COVERED service by most major medical health insurance companies. You will have the choice to decide whether you want to get a refraction at the time of the exam and if you decide that you want the prescription, you will be asked to pay the refraction fee at the time of the service.
I certify that I or my dependents have medical/vision insurance coverage. I assign directly to SCHWARTZ EYE ASSOCIATES all my insurance benefits for services rendered. I authorize the use of my signature on all claims submitted to the insurance company I have provided. SCHWARTZ EYE ASSOCIATES may use my healthcare information and may disclose such information to the above named insurance company and their agents for the purpose of obtaining payment for service/determining insurance benefits.
Payment in full for service/products are due at the time that services are rendered/ordered. I understand and agree that I am responsible for any balance on my account for services/ products I received. I understand that my insurance carrier may pay less than the actual bill for service. I agree to be responsible for the payment of all services/products rendered on behalf of me or my dependents. If any amount due for services or products is not paid within 60 days of the initial charge, the responsible party agrees to pay all costs for collecting or attempting to collect payment of the due amount.
I may request a copy of SCHWARTZ EYE ASSOCIATES HIPAA notice of privacy practices although it is displayed in the office.
I am financially responsible for all charges incurred by me and for all charges my medical or vision insurances plan does not pay, including but not limited to deductible, copays and/or services not covered.
IT IS MY RESPONSIBILITY TO KNOW WHAT MY INSURANCE COVERS.
PROFESSIONAL FEES ARE NOT REFUNDABLE.
The information I have provided is accurate to the best of my knowledge.
ABOUT YOUR INSURANCE There are two types of health insurance that will help pay for your eyecare services and products.
You may have both and our practice accepts both.
MEDICAL INSURANCE
VISION INSURANCE
Eyemed plans only cover ROUTINE VISION exams along with glasses and contact lenses. Vision plans only cover basic health screening for eye disease. They do not cover diagnosis, treatment or management of any eye conditions.
Medical Insurance must be used if you have any eye health, systemic health or ocular health complications. The doctor will determine if these conditions apply to you, but some are determined by your case history.
If you have both types of insurance it may be necessary to complete the exam on different days. The staff will discuss this with you.
We will bill your insurance plan for services if we are a participating provider for that plan. We will try to obtain advanced authorization of your insurance benefits so we can discuss with you what is covered. If some fees are not covered by your plan, we will bill you for any unpaid deductibles, copays, coinsurances or any uncovered services as allowed by the insurance contract.
PLEASE PROVIDE YOUR INSURANCE CARDS TO OUR STAFF I have read and agree with these policies.
