Our Financial Policy
Welcome to Friedrichs Family Eye Center Optometry. To help serve you better, please read the following regarding
our financial policy
1. Payment in full is due at the time of service unless an arrangement has been made prior to your
scheduled appointment. We accept cash, check, Visa, MasterCard, Discover. We do offer CareCredit, a financing plan
we offer as a separate line of credit with 90 days no interest, on qualifying accounts.* How do you plan to pay
2. In order for our office to file your insurance, vision or major medical, you must submit your social security # and
present you insurance card for photocopying prior to starting the exam or office visit and we must be able to obtain
authorization for the service. We will kindly supply you with the necessary forms to file for your own re-imbursement
from your insurance company.
3. We require full payment for materials at the time the order is placed. In special circumstances a 50% deposit may be
made, with the remaining balance due before any materials will be dispensed.
4. In our office, all patients wearing contact lenses receive tests and follow-up care that are above and beyond a
comprehensive exam. This contact lens evaluation is referred to as a “Contact Lens Fitting” and is performed on all
patients who wear contact lenses, every 12 months and a new contact lens prescription is established, whether or not
new contact lenses are purchased.
5. All checks returned by the bank for insufficient funds are sent to a collection agency. Any correspondence,
payment, and bank fees will be processed through the collection agency for us.
6. I understand that should my account balance become 30 days past due, my account will begin to accrue interest
calculated at $3.00 per month. I also understand that if the office is required to place my account with an agency or
attorney for collection, I agree to be responsible for all costs incurred in the collection of my account, including
attorney’s fees, interest from the initial statement and all costs. In addition, there will be a 25% service charge added
to the outstanding balance.
7. For our insurance patients:
- Although we pre-authorize services and materials prior to your arrival, we are told by your plan that that is not a guarantee of payment.
- If your deductible has not been met, your visit will not be covered any you may be charged today or after billing your plan.
- All co-payments are due at the time of your visit and before any orders are placed.
- In the event that we receive more payment than expected, you will be refunded. Also, if your insurance company has not paid your bill within 60 days, the responsibility for payment will be returned to you.
8. Regarding Medicare:
- Medicare does not pay for the refraction portion of an eye examination. This amount is payable at the time services
- are rendered.
- Medicare pays 80% of covered services after your deductible is met.
- Medicare does not pay for frames or lenses unless the patient has undergone cataract removal surgery.
- Routine eye exams are not covered.
read, understand, and agree to all of the above policies. As a responsible party, your signature indicates acceptance of
the aforementioned policies and authorizations.