Financial Policy

Fees and Payment Policy

Payment in full is required at the time of your visit and may be made with cash, personal check, money order, Visa, Mastercard, and Discover. Insurance co-payments are due at the time of service. If you are unable to make your co-payment at your visit, your appointment may need to be rescheduled. If the physician deems it necessary that you be seen, a $15 Co-Pay Service Charge will be added to your account. While filing insurance claims is a courtesy that we extend to our patients, all charges are your responsibility from the date services are rendered. Your insurance is a contract between you, your employer and the insurance company. We are not party to that contract. Before your visit, contact your insurance company to verify that we are participants in your plan, and the services you intend to receive are covered. In order for us to file a claim, you must present a CURRENT copy of your insurance at each visit and communicate changes in your personal information.

Not all services are a covered benefit in all policies, so it is very important that you understand the provisions of your individual policy. Insurance companies select certain services they will not pay for. Therefore we cannot guarantee payment of all claims by your insurance company. Reduction or rejection of your claim does not relieve you of your financial responsibility.

Please Note: Each visit is documented in your medical record and a diagnosis is made by the provider. Diagnoses are made based on medical information, not based on coverage by insurance companies. To request a diagnosis change solely for the purpose of securing reimbursement from an insurance carrier is considered insurance fraud and will not be done by our office. If you wish to use a routine eye care benefit, it is your responsibility to convey this to the doctor before the conclusion of your appointment.

Self Pay Policy

In order to address the needs of our patients without insurance, we offer a 10% discount off of our standard fees. This discount acknowledges the lower cost involved in billing and collections when a claim does not need to be submitted to a third party payer. In order to qualify, payment must be made IN FULL prior to or on completion of your visit or procedure. Any prior balance is not eligible for a discount. This discount applies to all medical services provided and is offered only at the time of service.

Medical Records

In order to comply with Ohio State law and HIPAA regulations, we charge a per page fee payable in advance, if you would like a copy of your records sent to you or another physician. This per page fee policy is available upon request. As always, if a collaborating physician (primary care or specialist) requests portions of your record to assist in your care, there will be no charge.

Miscellaneous Charges

Returned Check Charge:
Non Sufficient Funds (NSF) checks are subject to a $25.00 fee (in addition to fees from your bank).

Missed Appointment Charge:
You may be charged $25 for missed appointments without notification.