About Your Vision Care Plan & Your Medical Insurance

There are two types of health insurance that will help pay for your eye health services and products. You may have both types and [Your Practice Name here] accepts most visioncare plans and insurance plans in both categories: (1) vision plans and (2) medical insurance (such as Blue Cross/Blue Shield, Medicare and others).

• Vision Plans cover ONLY routine vision wellness exams and may include eyeglasses, sunglasses and contact lenses. Vision plans do NOT provide for MEDICAL EYE HEALTH CARE NEED.

• Medical Insurance MUST be submitted for any medical eye healthcare diagnoses and treatment care and follow-up.

• If you have both visioncare benefits and medical insurance plans, it may be necessary for us to submit and bill some services to one plan provider and some services to the other plan provider. We will follow a procedure called “Coordination of Benefits” to do this properly and to maximize your best advantage and least cost to you.

• Where some fees for services and products are not paid by your vision plan or medical insurance providers, you will be responsible for them, including deductibles, co-payments and non-provider services as specified by the insurance contract.

Please provide both your vision plan provider and medical insurance card(s) and identification, for your benefit, to our team member so we can make a copy. We will need your medical insurance or Medicare card on file in case we should need it in the future for submitting a claim on your behalf with your insurance.

I have read and accept this office procedure.

Signature: __________________________________ Date: ___________

Staff member to patient

“Katherine, you are more fortunate than many patients, because your savings are so significant compared with many of the plans available! I’m so happy for you!”