| GASTON EYE ASSOCIATES RESPONSIBILITIES: |
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- Provide you with cost effective state-of-the-art eye care.
- Provide you and/or your insurance company with a timely and accurate statement of all charges for services or goods provided.
- Upon request we will provide you with an estimate of your financial obligations (portion not covered by insurance) for any optical goods or services you may receive. However, under no circumstances does any estimate provided by Gaston Eye Associates guarantee payment by your insurance company.
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| PATIENT RESPONSITIBITIES |
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- Provide Gaston Eye Associates with your current insurance, employment, and demographic information at the time of each visit.
- Understand which services and providers are covered by your insurance company and obtain any necessary authorizations prior to your appointment.
- Pay in full your expected portion of the balance for all services, contact lenses, and glasses at the time of service.
- Pay in full within ten (10) days of receiving a statement any remaining balance on your account and any balance older than forty-five (45) days which has not been paid in full by your insurance company.
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| INSURANCE |
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| Gaston Eye Associates currently participates in over 40 different insurance plans Our staff works diligently to assist you in using your insurance coverage wisely; however, it is your responsibility to understand any limits and restrictions affecting your coverage for services, contact lenses, or glasses and secure all necessary authorizations. Insurance plans rarely cover all services and goods or pay the entire amount of covered services and goods. You will be expected to pay for the following at the time or service: |
- All co-pays, deductibles, and any co-insurance amounts not covered by a secondary insurance policy.
- The entire amount of any non-covered services.
- The entire amount for any services or goods provided if we have not yet received a required authorization from your primary care physician, insurance company, or employer.
- The entire amount of any services or goods provided if we are unable to verify your insurance coverage at the time of service.
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| You also authorize the release of any medical information necessary to process insurance claims. |
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| MEDICARE |
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| Gaston Eye Associates is a participating provider with Medicare; however, Medicate pays only a portion of your bill. Unless you have secondary insurance coverage in addition to Medicare, you will be expected to pay 20% of Medicare's allowed charge, any remaining portion of your annual deductible, and 100% of all non-covered services and goods at the time of service. If Medicare is not your primary insurance company, please inform the receptionist when you arrive for your appointment. |
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| CONTACT LENSES AND GLASSES |
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| All contact lenses and glasses must be paid in full prior to delivery. We prefer payment in full at the time the order is placed; however in special circumstances contact lenses and glasses may be ordered with a deposit of 50% or more of the total cost. |
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| BILLING |
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| Insurance reimbursement is a contact between you and your insurance company. Even though you may have an insurance claim outstanding, you may receive a statement each month for the outstanding balance of your account. If after forty-five (45) days your insurance has not paid your account in full, you will be asked to pay the remaining balance in full within ten (10) days of receiving a statement. We cannot accept final responsibility for collecting an insurance claim that has been lost, denied or disputed by your insurance company. Outstanding balances older than 90 days will be considered delinquent which will result in additional actions that damage your credit rating. Please call our office at 853-3937 should you have any questions or need to discuss your account. |
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| ACCEPTANCE: By submitting patient forms on this website, you are stating that you have read these policies and agree to its terms. |
