Financial Policy - As policy, we bill your insurance company as a courtesy to you, though you do remain responsible for the entire bill. Once the insurance company is billed, we will set aside the estimated portion due from the insurance company for 60 days. If you should receive any payment from your insurance carrier for services still due to us, please remit those payments to us immediately. If you have no insurance coverage, payment in full will be expected at the time of service. You must establish any other type of payment arrangement with the billing department prior to your visit. For Centennial Care (Medicaid), Medicare, Workers Compensation and Managed Care claims, we will bill all services. No payment other than applicable copayments or coinsurance will be expected from the patient at the time of service, unless the services are denied for reasons of expired eligibility or acceptance. Please note that proof of Medicaid eligibility is required at the time of service. Our insurance specialists will do their best to authorize Medicaid patients prior to the visit and will be sure to reach out to the patient if there is an authorization issue of any kind. For our Medicare patients, Lovato Eyecare is a proudly participating provider and as such, we accept Medicare assignment. You are responsible only for the coinsurance, deductible and any non-covered services.
Return Policy for Eyewear - All sales of eyeglasses and sunglasses are FINAL, except when the cancellation & order occur on the same business day. Eyeglasses are custom-made medical devices created just for you. For this reason, there are no returns or exchanges for any purchased eyewear, such as lenses and frames. The buyer may return to the office as many times as necessary or desired for the frame “fit” to be adjusted for the lifetime of the product. For eyeglass Lenses, a free 1-Time-Prescription-Recheck is available within 90 days of the original exam date. If there are any discrepancies between the doctor’s prescription and the lenses manufactured by the lab, these changes will be provided at no charge. All our lenses & frames have a warranty for any manufacturer defects for up to one year from the date of purchase, which does not include accidental damage or loss.
Return Policy for Contact Lenses - Non-Specialty soft contact lenses may be returned for a full refund or exchange within 6 months of purchase if the boxes are unmarked and unopened. Sales of specialty gas permeable and hybrid lenses are final. During the trial period, if changes to the lenses need to be made, any exchanges or returns will be granted at no charge if the time frame is within the 90-day manufacturer exchange/return policy.
Eyewear & Contact Lens Pick-Up - All eyeglasses and contact lenses that have been prescribed, fitted, and purchased by the patient will be kept in the office for up to 1 year from the date of purchase. If the patient does not pick up or arrange for shipping of their eyeglasses or contact lenses, materials will be either donated to a local charity or disposed of properly without refund.
Patient Communication
- I consent to be contacted by regular mail, by e-mail, or by telephone (including a cell phone/wireless number and SMS text messaging) regarding any matter to my account(s), by Lovato Eyecare or any entity to which Lovato Eyecare assigns my account(s). I consent for Lovato Eyecare to use technology, including automated technology such as autodialing or pre-recorded messages, to contact me at the address, e-mail address, or telephone number, including any cell phone/wireless number, I have provided; or any updated or additional contact information I provide at a later time. This consent applies to all healthcare providers and agents covered under this agreement.
Assignment of Insurance Benefits
- I hereby authorize direct payment to Lovato Eyecare of any insurance benefits otherwise payable to me or on my behalf for services performed by any Lovato Eyecare physician. I understand that my insurance is billed as a courtesy and I am financially responsible for all charges not covered by this assignment of benefits. Deductible, copayments, and coinsurance are my responsibility.
Referrals & Authorization for Release of Information (Medical Release)
- I understand that if my insurance requires a referral for a Specialist Visit, it is my responsibility to obtain and provide this documentation. If I fail to provide a referral, I understand my visit will be rescheduled.
- I authorize Lovato Eyecare to release medical information concerning my care and treatment as may be required by the third-party payers for the purpose of processing claim payment.
- I authorize Lovato Eyecare to release and receive ALL my prior health records and subsequent Protected Health Information (PHI) from any previous office for the purpose of diagnoses, treatment, and referral services.
Financial Responsibility for Self
- I agree to be responsible for any co-payments, deductibles, or other charges of Lovato Eyecare. I agree, subject to state and federal law, to pay all costs, attorney fees, expenses, delinquent charges and interest in the event Lovato Eyecare or any entity to which Lovato Eyecare assigns my account(s) has to take action to collect same because of my failure to pay in full all incurred charges within 60 days after receipt of the bill.
No Show Policy
- I understand that if I do not keep two (2) consecutive appointments without calling to cancel or reschedule, I will be dismissed from Lovato Eyecare's medical practice. Upon request, my medical records will be transferred to another provider.