Eye Care Services , Insurances & Types of PAYMENT ACCEPTED
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Types of Payment Accepted
We accept Cash, Personal Checks, Debit Card, Master Card, Visa, Discover, AMEX and CareCredit.
Insurance Plans
We participate with VSP, Medicare, Eyemed, NVA, Blue Shield, Vision Benefits of America, Aetna, Davis, United Healthcare. Check with our staff if you have other types of coverage.
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Patient Financial Responsibility
I hereby authorize this vision care provider to apply for benefits on my behalf for covered services rendered by them. I also assign my benefits and request that all payments from EyeMed Vision Care made directly to the vision care provider. I agree to assume responsibility for full payment pending any remaining balance that is not covered by EyeMed. I certify that the information I have reported with regard to my coverage is correct. I further authorize vision care provider to release to EyeMed and its agents any information related to this or any related claim.
Patient Name:
Signature/Date
I hereby authorize this vision care provider to apply for benefits on my behalf for covered services rendered by them. I also assign my benefits and request that all payments from EyeMed Vision Care made directly to the vision care provider. I agree to assume responsibility for full payment pending any remaining balance that is not covered by EyeMed. I certify that the information I have reported with regard to my coverage is correct. I further authorize vision care provider to release to EyeMed and its agents any information related to this or any related claim.
Patient Name:
Signature/Date