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.
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 not be able to make any future appointments at any of our offices.
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.
Vision Care and Medical Insurance
We often have patients that have both vision insurance (for example, VSP or EyeMed) and medical insurance (for example, Blue Cross, Aetna, Blue Shield, or Medicare). They are very different in terms of the services they cover, and it’s important for our patients to understand these differences.
Vision insurance is designed mainly to cover determining a prescription for glasses, to help pay for glasses or contact lenses, and to cover a yearly routine evaluation of the health of the eyes in a healthy patient that has no particular problems or symptoms. It is not equipped to deal with and does not usually cover medical conditions, injuries, and/or treatments. Medical insurance is designed to cover you when you have a medical problem, including one that affects your eyes. Medical insurance does not cover routine services or examinations for glasses, or routine vision problems such as nearsightedness, farsightedness, and astigmatism. Those are only covered by your vision insurance.
When a medical diagnosis or medical condition is present that affects your eyes, such as high blood pressure, high cholesterol, or diabetes, to name just a few examples, or you have an eye disease or eye problem such as an infection (pink eye), dry eyes, allergy, or cataracts, again, just to name a few, we must file the claim with your medical insurance, and the co-pays and deductibles for that insurance will apply. Your vision plan does not cover these kinds of problems. Our office does not make these rules, they are made by the insurance companies themselves, and we must comply with them.
There is often no way to know prior to your examination which type of insurance will be the right one to file your claim with. We make every effort to join as many insurance panels, both medical and vision, as we can for your convenience. If we are on your insurance company’s panel we will file those claims for you. In the event that we do not accept your medical or vision insurance we will provide you with an itemized receipt so that you may file a claim for reimbursement with your insurance company yourself. If you have any questions, please let us know.
I understand the information I’ve just read about the difference between vision and medical insurance. I authorize Dr. Norman Shedlo P.A. of the Eyecare Center of Maryland to file my claim with the appropriate insurance based on the reason for my visit and the results of my examination.
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 $25.00, effective February 5, 2020. It is the patient’s responsibility and is payable at the time of service.
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.
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.
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.
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.
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Document Name: Office Policies
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