Office Policy:
Please read and sign at bottom. Doing so let's us know the patient/guardian has read and understood the office policy terms and conditions, and is authorizing Bay Area Eye Center to provide treatment.
- All visits to the office are due and payable in full at time of service.
- Fees paid for services (examination, contact lens evaluation, ect) are non- refundable. *There is a separate charge to be evaluated for contacts lenses. By State Law, a patient must be re-evalutated each year in order to continue wearing contact lenses regardless of prescription/brand change.
- By authorizing to receive treatment, the patient/guardian is aware that Bay Area Eye Center cannot guarantee payment from their insurance company at this time. If it is determined that the patient is not eligible for services for any reason(lapse of coverage, exceptions in contract, ect) I understand that I, the patient, will be responsible for payment of all services that were not covered by the insurance company.
- There is a re-stocking fee for all returned frames, lenses, and contacts. Materials must be returned within 30 days from the purchase date (contacts must be unopened). Most frames have a One Year Warranty for defects by the manufacturer only. Warranty is void if the frame is discontinued. Only one remake of lenses is allowed within 60 days from the date of purchase. All other remakes will be at the full charge to the patient.
- Medicare specifically excludes coverage for the $25 refraction fee. Refraction is considered a non-covered service by Medicare and will be billed to the patient on the date of service. A paid receipt will be provided if you wish to pursue payment from your Medicare supplement or vision plan.