Larson Eye Care has instituted this policy as part of its Compliance Program to comply with applicable federal, state, and local laws and sound ethical business practices.

As the patient, you are financially responsible for all services provided by Larson Eye Care.  We will file all claims for our services with your primary and secondary (when applicable) insurance companies.  Once your insurance has provided payment, you will be billed for any remaining balance that may be due.

Your Medical Insurance
Your medical insurance policy is a contract between you and the insurance carrier.  Please take time to read and understand the procedures outlined in your policy handbook provided by your insurance company.

Co-payments, Deductibles and Coinsurance
We contract with many area employers, HMO’s, PPO’s, various insurance companies, Medicare and Medicaid.  Because of our contractual obligation with these plans, we have agreed to accept a specific reimbursement for our services.  However, you may still have financial responsibility for any unpaid balance of the contractual amounts.

Please pay your Co-Payment at the time of your office visit
We cannot waive any co-payments, deductibles or coinsurance amounts defined as patient responsibility.  Such a waiver may violate state and federal laws.  For your convenience, we accept Visa, MasterCard and Discover.  If you are unable to pay the co-pay at the time of service, we would be happy to reschedule the appointment.  If you prefer to keep the appointment and be billed for the co-pay, a $10 statement fee will apply.

Prior Authorization and Referral Forms
If your medical insurance plan requires you to have a referral form prior to an office visit, please obtain the proper referral prior to your appointment.  If a referral is not obtained, your appointment may have to be rescheduled so that you are not financially responsible.  We will pre-authorize any scheduled procedure on your behalf.

Insurance Patients
After your insurance has reimbursed Larson Eye Care, you will receive a statement if there is a remaining balance due.  Please pay your bill upon receipt.  We accept payment by cash, check, Visa, MasterCard and Discover.  If your balance is $300 or over and you are unable to pay your balance in full, 3, 6 and 12 month interest free financing is available – please contact our billing office for additional information.  There will be a $25.00 fee for any returned checks.  All parents are responsible for all fees and services rendered to a minor.

Self Pay – No Insurance on File
If you have no medical insurance, choose not to use your benefits, or you request a service that is not covered by your insurance, you will be asked to pay for your services at the time of your visit.  If services provided are $300 or more, 3, 6 and 12 month interest free financing is available – please contact our billing office for additional information.  If you feel that you may qualify for Charity Care, the appropriate form(s) must be completed prior to the services being rendered – please contact our billing office for additional information.  There will be a $25.00 fee for any returned checks.  All parents are responsible for all fees and services rendered to a minor.

Charity Care
Charity Care applications are available through our billing office.  All applications must be submitted with requested documents (W-2 forms, etc.) in order for Charity Care to be considered.  We follow the Federal Register Poverty Guidelines to establish charity grants.

Missed Appointments
We certainly understand if you need to cancel your appointment due to illness or emergency.  However, regularly canceling an appointment within 24 hours of the appointment or regularly not showing for an appointment may result in a $25 fee payable by you.