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Eyeconic Vision Care

2311 Berlin Turnpike ⇼ Newington, CT 06111 

175 West Rd ⇼ Ellington, CT 06029

Notice of Practice Policies 

Financial Policy 

Eyeconic Vision Care will file claims to your insurance company, when applicable, as a courtesy to you. It is important for you to understand that the contract exists between you and your insurance carrier. We will attempt to verify your insurance benefits and coverage prior to your visit however it is not a guarantee of benefits for services rendered at our facility. We do not guarantee the accuracy of benefit information received from your insurance company. Should you have specific questions about your coverage, please contact a representative from your insurance carrier directly. It is required that all charges in which you are financially responsible be paid in full at the time of service. Statements will be issued and mailed to you for any uncovered charges after the insurance company has successfully processed and issued correspondence to our claim. Please understand that you are financially responsible for any and all charges incurred during the course of authorized treatment. 

Self-pay patients are required to pay in full at the time of service unless prior arrangements have been made with authorized personnel. 

Eyeconic Vision Care maintains a returned check fee policy of $35 in addition to the check amount. We will not accept check payments from any patient after one (1) returned check. In the event that your account becomes delinquent more than ninety (90) days, you will be eligible for referral to a collection agency. Once your account has been sent to collections, an additional fee of 30% will be accrued to your account for the collection charges. All missed or cancelled appointments with less than 24-hour notice may be subject to a fee no more than $40. If our office has not received communication from you to confirm your appointment within one day prior to your appointment, we reserve the right to remove you from our schedule and a “no-show” fee may apply. There are NO refunds for any services or custom products (i.e., glasses, contacts, etc.) 

Medical Insurance vs. Vision Riders 

A routine diagnosis may or may not be covered by your medical insurance plan. We will attempt to verify coverage for routine diagnoses before your visit. If there is no medical diagnosis found during your exam, and your insurance company does not provide routine coverage, you will be responsible for the charges upon insurance denial. Managed Vision Care (MVC) such as VSP and EyeMed may offer limited routine coverage however will not provide benefits for any medical findings or additional medical testing. If a medical diagnosis (as defined by insurance) is revealed during your exam, the doctor may recommend an additional visit for testing or follow-up care. The additional visit and any associated medical tests will be billed through your medical insurance without exception. Please note, in the absence of a pre-existing condition, we are unable to determine a medical/routine diagnosis until the exam is complete.

Assignment of Benefits 

• I understand that I am fully financially responsible for any and all charges incurred during the course of authorized treatment, including those not covered by my insurance benefits. 
• I further understand that all applicable fees such as but not limited to copays and contact lens fitting fees are due on the date that services are provided and agree to pay such charges in full. 
• I hereby assign all medical and surgical benefits to Eyeconic Vision Care, including major medical
  benefits, to which I am entitled. 
• I authorize and direct my insurance carrier(s) to issue payments to Eyeconic Vision Care for medical
  and/or routine services rendered to myself or minor children covered under my policy.
   

Authorization to Release Information 

• I understand I have the right to request a coordination of benefits between my medical carrier and Managed Vision Care Plan. I understand that this request is not a guarantee of payment through either plan and that my request may be denied dependent on the provisions of my medical and MVC plans. Should my request be granted, I further understand that this coordination will exhaust my yearly benefits for both plans. 
• I authorize Eyeconic Vision Care to release any information necessary to insurance carriers regarding my treatments, process insurance claims generated during my examination, and allow a photocopy of my signature to be used to process insurance claims for the period of my lifetime.