Patient and Insurance Information

It is very important that we have accurate contact information for all our patients including, name, date of birth, address, phone and email. We use the information for insurance claims and contacting you for any follow-up such as appointment reminders, medical issues, eyeglass pickup and billing adjustments. We will not be responsible for any lost benefits or time to you, if our office is unable to reach you. Please notify us of any contact changes.

If you are using insurance, your insurance must be verified and authorized before your visit or you will be charged our usual and customary fees, to be paid at the time of your visit. No changes to insurance payment arrangements will be accepted after your visit date. If you present vision/medical insurance that is out of state, or we don’t recognize, or cannot verify, we will be happy to see you, however, you will charged our usual and customary fees, to be paid before the visit. We will provide you with a statement you can then submit to your insurance company for reimbursement.

Appointment Cancellations

We require patients to notify our office of a cancellation at least 24 hours prior to their appointment so that your time slot will be available to another patient. If we are not notified at least 24 hours before your scheduled time, you’ll be considered a no show and will be charged $50.  We also reserve the right to not make any future appointments for you at our office.

Co-pays and Deductibles

Benefits will be verified before services are rendered. Verification of eligibility does not guarantee payment for services. All co-payments, deductibles, and/or fees for services not covered by the insurance plan are due at the time that services are rendered. If benefits cannot be verified at the time of service, the usual and customary fee is due in full by the person responsible for the account, and it is the insured’s responsibility to collect any benefits from their insurance company directly. Please note that contact fittings/evaluations are not covered services for most insurance plans.

Refraction and Medical Insurance

A refraction is a measurement of the refractive error of your eyes to determine your best vision and provide a prescription for glasses or contact lenses. This is usually a covered procedure with your vision plan.  A refraction is also done in order to establish the quality of your vision in the presence of certain diseases. Most MEDICAL insurance companies, including Medicare, will consider refraction as a non-covered service. Therefore, the charge for the refraction when using medical insurance is $35.00, effective August 1, 2021.  It is the patient’s responsibility and is payable at the time of service.

Eyeglass Orders

We will not send any “patient’s own frame” (a frame not purchased at our office or obtained through your insurance) to any insurance lab for any covered lens benefits. If you still wish to use your own frame, we will supply our own lenses and edge the lenses in our lab at our regular fees. You will be charged an additional fitting fee for using your own frame. In addition we will not be responsible for any loss or damage to your own frame.

We require full payment on all orders before they will be processed. No exceptions. Your order must be picked up within 45 days from the date of notification that your glasses are ready. If your glasses are not picked up, or shipping arrangements are not made, your glasses order will be forfeited and no longer available to you.  Fees will not be refunded for orders not picked up and your payment will be applied to our cost of replacement.

All of our glasses are custom made for each patient, and as such all purchases are non-refundable. If you are dissatisfied with your prescription, (adaptation, blurry vision, etc.) please notify us within 30 days and make arrangements to bring your glasses in. No changes will be made after 30 days. We will not replace or exchange eyeglass frames unless there is a manufacturer’s defect.

We will check your glasses to make sure the lab used the right prescription and the glasses were made and adjusted correctly. If you require another vision evaluation with the doctor, you will be charged our usual and customary fees for the visit. We will warranty all products for 30 days against manufacturer’s defects ONLY. Glasses that are broken due to accidents, misuse or acts of God are NOT covered. We will honor lens and coating warranties that extend longer than 30 days, if these warranties are guaranteed by the insurance company and/or lens manufacturer.

Refunds

There will be NO REFUNDS for professional fees (contact lens fitting fees, examination fees, etc.). If there is a need for a refund (i.e. the patient is accidentally charged incorrectly), we reserve the right to issue refunds via check only, even if the purchase was made in cash. Checks will be sent by mail, and you should receive the funds in 1-2 weeks. Credit cards can only be refunded to the same account used for the purchase. If a patient paid via personal check, the check must have cleared before we will issue any refunds. By signing below, I am confirming that I have read and understood the above office policies. I understand that if I have any questions or concerns regarding these policies, I am responsible for contacting a staff member for clarification before services are rendered.

Financial Responsibility

By signing below, I request that payment of authorized insurance benefits be made on my behalf to Norman Shedlo, O.D., P.A. for any services furnished to me. I authorize any holder of medical information about me and any information needed to determine benefits payable for services, be released to the Center for Medicare & Medicaid services (CMS), agents and/or third party payers. I understand that verification of eligibility does not guarantee payment for services. I agree to be fully and personally liable for payment if benefits are denied. I am accepting charges for services rendered that are not covered by my insurance and agree to pay for services when rendered unless prohibited by law such as Maryland medicaid beneficiaries.

Privacy Disclosure

I acknowledge that I have read a copy of Dr. Norman Shedlo, PA.’s Notice of Privacy Practices. A printed copy is available in our office and on our website.