Middletown and Settlers Walk Eye Care
Financial Policy Statement and Patient Agreement
- Our billing department will submit a claim for materials and services rendered for patients that are members of plans that we are in network with. Patients must provide all necessary insurance information, including any special forms, prior authorizations, cards and member information prior to services being rendered or material being ordered.
- Patients are responsible for payment of any services or materials not covered by their insurance plan. Our staff calculates and collects what we estimate to be your out-of-pocket for these services and materials but cannot guarantee your out-of-pocket total until all claims have been filed and payment received from your vision and/or medical plans. It is the patient’s responsibility to pay all deductible, co-insurance and/or non-covered services within sixty (60) days after insurance has processed your claim and identified your portion. We will collect the contracted fee for services or 50% of the charge when the deductible is not met at the time of service.
- The patient is responsible for making payment even if they are disputing the claim with their insurance company. Middletown and Settlers Walk Eye Care will refund a patient’s payment if insurance re-processes a claim and makes any additional payment.
- Middletown and Settlers Walk Eye Care require a 24-hour notification via phone while the office is open if the need to cancel an appointment arises. This policy allows us to fill a needed time slot and allows your doctor to accommodate a patient who may need acute medical eye care. Failure to cancel an appointment 24 hours prior to the scheduled appointment time may result in a $25.00 cancellation fee depending upon the type of service. Multiple cancelations may result in the inability to make pre-appointments and patients may be dismissed from the practice.
- Please note that in conformance with HIPAA regulations, Middletown and Settlers Walk eye Care will not disclose any protected health information, including financial information, without your authorization, except as described in our Notice of Privacy Practices.
- Middletown and Settlers Walk Eye Care accept cash, check, debit card, MasterCard, Visa, Discover, American Express or Care Credit for payment of all services. We reserve the right to refuse payment by check if we have previously had a returned check on the account.
- I understand that in the event an unpaid balance (over 90 days past due) is placed for collections with any third-party collection agency, a collection fee will be added to the total amount due and owed by me. The fee represents the cost incurred by Middletown and Settlers Walk eye Care to collect amounts owed under this agreement by the signer’s failure to pay as specified in this agreement. Please know that if your patient balance remains unpaid you may be discharged as a patient of our practice.
Middletown and Settlers Walk Eye Care Eyewear Policy
Returns: Due to the custom-made nature of prescription eyeglass lenses, no refund can be given once the lens manufacturing process has been started. At the discretion of the office manager or owner we may refund your original payment minus a 25% restocking fee.
Prescription, Lens Style or Material Changes: Within 90 days of receipt of your eyewear, if for any reason you feel that you are not seeing well with your new prescription, unsatisfied or unable to adapt to any lens style or material (progressive lenses, bifocals, transitions etc…), please come in and meet with one of our opticians. If the optician determines a prescription re-check is necessary you will be scheduled for a short visit with the prescribing doctor at no charge and the lenses will be remade also at no charge. If the optician or doctor determines your lenses need to be remade to a lens product of equal or lesser value there will be no charge. If there is an upgrade to a more expensive lens option the higher cost will be collected minus your original payment. If a downgrade in the type of lens or material is needed there will be no refund of the original charges due to the custom nature of the lenses. Please note that if the prescription is from an outside doctor you will need to see them for a re-check within our 90-day remake policy. This is a one-time courtesy unless approved by the office manager or doctor.
Frame Changes: Within 60 days if you are unsatisfied with the frame you selected for any reason you may come in and re-select a frame and we will remake your lenses in the new frame at no charge. If the new frame is more expensive than the one originally selected you will be charged the price difference. Due to the expenses in materials and labor we have incurred, no refunds can be given if the new frame is of lesser cost. This is a one-time exchange courtesy only.
Frame and Lens Warranties: All of our frames and lenses, with the exception of uncoated plastic lenses, value packages and clearance frames, carry at least a one-year, one-time warranty against any defects in materials or workmanship and covers normal wear and tear. The frame or defective parts will be replaced or repaired once during the warranty period. Excessive abuse such as being run over by a car, chewed by a dog or loss is not covered under the warranty. All parts, pieces and lenses must be returned in order to be replaced under the warranty. Patients purchasing a premium Anti-Reflective lens will have the warranty extended on both the lens and frame for two years and may be used multiple times. All warranty claims are subject to a small handling fee.
Eyewear Insurance/ Benefits: If you purchased eyewear using an eyewear benefit plan, your insurance company may impose policies that will supersede ours since in many cases they have assumed the role of manufacturing your eyewear. If you have any questions regarding their specific policies, please contact them directly.
Use of a Patient’s Own Frame: Frames may have inherent defects from manufacturing or developed through normal wear and tear. It is impossible for us to determine defects through general inspection as these defects may only become evident when we insert new lenses or remove old lenses. This may also occur through routine adjustment or minor repair. Although we always take the utmost care with your frames, we cannot be held liable should any damage occur during adjustments or lens replacement. This applies to frames that were purchased elsewhere and frames that were purchased in our practice that are outside of the manufacturer’s warranty. We will require a waiver in order to process orders with these frames.
Contact Lens Fitting Policy
Middletown & Settlers Walk Eye Care
In order to renew or issue a contact lens prescription our office requires a corneal evaluation in addition to a routine vision exam annually with our optometrists. Contact lenses are a medical device worn on the eye and therefore must be evaluated for fit, vision and safety due to complications up to and including blindness. This corneal evaluation is an additional charge which may or may not be covered by vision insurance but is ultimately the responsibility of the contact lens wearer.
- Our evaluation and fitting fees involve the doctor’s evaluation of the cornea and determining the appropriate brand, fit and prescription.
- Contact lens fittings must take place within 90 days of a full eye examination.
- Follow-up visits if deemed necessary by the doctor are included in these fees. Training and instruction of insertion and removal of contact lenses as well as proper care of the contact lenses by our staff are included in the fees for new contact lens wearers.
- 3 training sessions are included in the initial fitting fee for new wearers.
- All follow-ups and training must be completed within a 90-day period from the date of the initial evaluation.
- Any additional training or follow-up will be subject to additional fees.
- Patients must be compliant with their wearing schedule and lens care instructions in order to be approved to continue to wear contact lenses at their annual evaluation.
- You are responsible for keeping all follow-up appointments to finalize your prescription.
- Your prescription will not be released until the doctor has finalized it and any associated fees have been paid.
- All fees are nonrefundable.
- New wearers must be able to remove and insert their contact lenses without assistance multiple times before leaving the office with them.
- I agree to receive texts and/or emails from contact lens manufacturers or distributors in regards to my contact lens orders.
- Prescriptions are valid for one year.