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Financial Policy
Our goal at DANIEL VISION CENTER is to provide the best eye care service and products that satisfy our patients’ needs at a reasonable price. Your understanding of our financial policy is an essential part of your eye care and treatment. If you have any questions regarding this policy, please feel free to discuss them with our staff.FULL PAYMENT FOR PROFESSIONAL SERVICES IS DUE AT TIME OF SERVICE. Acceptable forms of payment include cash and personal checks. Also, for you convenience, we accept Visa, MasterCard, and Discover. If eyewear or contact lenses are ordered, a minimum 50% deposit is required and the balance is due upon delivery. A $30 FEE WILL BE CHARGED FOR RETURNED CHECKS. Your insurance contract is an agreement between you and your insurance carrier. Although we participate with many plans, it is the patient’s responsibility to make payment in full, should we not participate with your plan or payment is denied by your insurance company. If we have not received payment from your insurance carrier within 45 days of initial service the balance will be transferred to you. As a courtesy, we will file your insurance today (up to two plans) on your behalf. For patients enrolled in plans with which we participate, co-pays and deductibles are due at the time of service. We reserve the right to turn any patient over to a collection agency if it is deemed that the account has been in default of payment. If we turn your account over to a collection agent, you will be responsible for any administration fees, attorney fees, and court cost incurred. OUR OFFICE HAS A $30.00 FEE FOR ALL MISSED APPOINTMENTS unless we receive 48 hour advanced notice. Our answering machine can take messages in the event that you need to reach us after regular office hours to cancel an appointment. I have read and understand the financial policy of this practice and I agree to be bound be its terms. I understand that I am financially responsible for al changes whether or not paid by my insurance. I authorize my insurance company to pay to the doctor all insurance benefits otherwise payable to me for services rendered. I authorize the use of this signature on all insurance submissions. Signature________________________________________ Date____________________ |
 
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