Your eye exam today will either be a ROUTINE EXAM or a MEDICAL EXAM.

A Routine Exam is when a patient has no medical history or problem that would directly affect the visual system. Our comprehensive routine exam includes a total ocular health assessment, refraction, dilation, and a prescription for glasses. Vision insurance plans are used for these types of well vision visits.

A Medical/Problem-Focused Exam is when the doctor identifies the presence of disease or if a patient is experiencing pain, ongoing headaches, dry eyes, or other symptoms indicative of a medical issue. A medical exam is necessary for all glaucoma and diabetic patients, as well as any patients with a medical history that directly affects the visual system. Medical/Health insurance plans are used for medical exams.

INSURANCE AND FINANCIAL POLICIES

If you do not inform us that you have a vision plan or medical insurance before services are rendered, we must assume no coverage exists. Please provide our office with your current insurance information before arriving to your appointment.
For your convenience, we will attempt to contact your insurance company to verify your benefits at our clinic prior to your initial visit.
We will gladly file your vision/medical insurance claim as a courtesy to you.
We have no control over your contract with your insurance company.
Because insurance policies vary greatly, we can only estimate coverage in good faith. We at no time guarantee what your insurance will and will not cover.
I agree this office will not back-file claims or refund fees after services are rendered due to lack of notification of vision or medical benefits. I, therefore, agree that I am responsible to file my own claim if I discover I have vision or medical benefits after services or products are rendered.
I understand that I am financially responsible today for all fees. I also agree that I am financially responsible for any and all fees not collected in full on the date of service or should my insurance plan deny payment or apply it to my deductible for services or materials rendered.
I understand that prescription eyewear is custom made and, while it cannot be refunded, every reasonable effort will be made to make sure that I am satisfied with my eyewear purchases.
I acknowledge that I will be given access to all of my prescriptions from today's visit including medicine prescriptions, glasses prescriptions, and contact lens prescriptions. I also acknowledge that I will always have access to my prescriptions through my doctor, including paper copies when requested and requests through online access twenty-four hours a day, seven days a week.

By signing this, I acknowledge my understanding of the policies stated above and give Alabama Family Eye Care my consent to treat and permission to file to my insurance.