Office Policies
(Please review)
As a condition of seeking and receiving care at our office, you acknowledge that you understand and agree to the following office policies:
Insurance:
We are pleased to accept many vision and medical insurance plans. It is your responsibility to know what insurance plan(s) you have, what they do and do not cover, and provide us all of your current insurance information before services are rendered. We request you provide us with your insurance information at the time you make an appointment. Federal “no surprises” legislation requires us to attempt to verify we are in network providers with your insurance before providing care; it also requires us to notify you in writing if we are not in network and advise you of this fact and your options for receiving care. If you fail to provide your insurance information to us, we cannot verify we are in network, and you are forfeiting your rights under this law.
If your insurance changes between the time you have provided the information to us and the time of your visit, it is your responsibility to inform us of the change as soon as possible.
Copayments and any non-covered charges are due on the date of service. Most vision plans provide coverage for a routine eye exam, which specifically excludes the evaluation and management of any medical condition(s). If your visit includes the evaluation and/or management of any medical condition(s), we will bill your medical insurance for your visit, which may result in a higher out of pocket cost due to the copays and deductibles your policy specifies. If you have more than one insurance plan which covers your routine visit, you consent to us choosing which plan we will use.
As a courtesy to you, we will submit claims directly to your insurance company. While we will make our best effort to verify your insurance coverage before providing services to you, this is by no means a guarantee that your insurance will actually pay your claim.
There is no way that we can be absolutely certain services or materials will be covered by insurance, so services and materials are not provided contingent on insurance coverage. You should contact your insurance company in advance to verify coverage if you are unsure, and we can provide you with anticipated diagnosis and procedure code(s) at your request. In the event that your insurance company does not pay your claim, whether due to an unmet deductible, a requirement for Primary Care Physician (PCP) referral, or any other reason, you agree to personally and promptly pay any balance owed. We accept no responsibility in collecting overdue insurance claims or negotiating settlement on disputed claims. To be clear, our responsibility is to submit a correct claim to your insurance in a timely manner. If we do this and do not get paid, payment becomes your responsibility. If at any time in the future, your insurance company reverses payment, you agree to reimburse us promptly for the amount of the reversal.
We reserve the right to refuse to resubmit claims that have previously been denied, to refuse to submit claims that we know will be denied due to plan limitations, and to request prompt payment from you for any claim that has remained unpaid for more than 90 days.
Claims cannot be re-processed to insurance after the fact. If you would like us to use your vision insurance toward an order for glasses or contacts, you must tell us before the order is placed. After an order is placed, insurance cannot be applied or changed. This is because different insurances have different requirements for what can be ordered, how it can be ordered, and what copays apply.
Vision Care Plan Acknowledgement
Our role is to be your advocate and to help you to maximize your benefits. We want to make sure you receive everything you are entitled to and we want you to be happy and satisfied. We also want to make sure you are aware of the following:
- With few exceptions, vision care plans provide routine exams only, not medical eye care.
- Eyewear ordered through your vision plan is not sold by us. We order it through your vision plan, and they pay us a small fee to order and dispense it to you. We use lenses from their formulary, submit your order to a lab they specify, and charge the copays they require. We must operate within the constraints they set, and accept whatever (heavily discounted) payments they provide us.
- If you are unhappy with the eyewear your insurance company provides we will be your advocate and assist you, BUT your insurance company makes the final decision about how any concerns will be resolved.
- Your insurance company does not provide refunds, and any warranty is according to their terms.
- Eyewear orders are submitted to your insurance company immediately once the order is finalized, and changes cannot be made after submission.
Eyewear:
All eyewear purchases require a minimum 50% non-refundable deposit before orders will be placed; this deposit will not be refunded if the order is cancelled. Any order with a balance due after 90 days from the date glasses are ready for pickup will be considered canceled. Eyewear purchases are non-refundable. If eyewear is to be ordered through your vision insurance, it is your responsibility to make this clear to us, and provide the insurance information, before the order is placed. Orders are submitted to the lab immediately, therefore cancellations, order changes and insurance changes are often not possible after the order is finalized. If we are able to change your order after it is submitted, we will require a $50 fee to cover our time and trouble to do so. Manufacturers’ warranties cover lenses and frames for one (1) year after dispensing against defects in materials and workmanship; minor cosmetic flaws due to normal wear and tear and breakage due to abuse are explicitly excluded. Lenses with scratches significantly interfering with vision may be replaced one time only during the first year of use at our sole discretion; scratching due to abuse is explicitly excluded.
Problems with eyeglass lenses & eyeglass lens prescriptions:
Occasionally patients don’t do well with their new eyewear. In these cases, we are happy to troubleshoot provided the problem is brought to our attention within 30 days of dispensing, or 90 days of ordering, whichever comes first. The first step in the process will be a verification of the glasses with the optical staff, which can be done on a walk-in basis. They will (triple) check the Rx, the measurements, and the appropriateness for the intended use. If all of these are as expected, the patient will be scheduled for an appointment for a courtesy Rx recheck. If the prescription requires modification, we will replace any lenses ordered through our office as a courtesy, subject to any requirements or limitations of any vision insurance involved.
Patients who are unable to adapt to Progressive Addition Lenses (PALs) dispensed by us, after a reasonable effort, will be afforded the opportunity to have their lenses replaced with a lined bifocal or single vision lens at their option, provided their concerns are brought to our attention within thirty (30) days of dispensing, or 90 days of ordering, whichever comes first, subject to any restrictions of vision insurance if applicable. No refunds will be made in this situation.
Glasses made elsewhere:
Patients have the right to purchase eyewear anywhere they choose, and we will provide a printed prescription, with PD, to every patient for which a prescription is determined. Patients are cautioned to choose carefully where they choose to shop for eyewear, as poor quality and/or poor service may be associated with low cost. In particular, online eyeglass sellers have no obligation to comply with industry standards and state regulations designed to protect consumers – “caveat emptor.”
Asking us about purchasing glasses online is as rude as asking your waitress where to get ice cream when she offers a dessert menu; please don’t. We politely decline to assist you in purchasing glasses elsewhere.
When patients have problems with glasses made elsewhere, this presents a delicate situation. Patients should ask the optical that made the glasses to double check that the glasses are within spec to the Rx and verify all of the fitting measurements. If there are no problems found, they should then have the glasses checked by our optical staff. If the Rx is within spec and fitting measurements are correct, a courtesy Rx recheck appointment will be scheduled. Please note that we are entitled to charge for verifying another optician’s product, and the fee for this is $25. If the Rx and measurements check out, we will waive this fee.
Please understand that we do not take responsibility for any costs associated with updating glasses made elsewhere in the event the Rx needs to be adjusted. It is the patient’s responsibility to understand and accept their vendor’s policy on Rx changes.
Outside prescriptions:
We are happy to fill outside prescriptions. If the prescription is dated more than 6 months prior to the order date, any Rx changes will be at the patient’s expense. If the prescription is six months old or less, we will honor a Dr.’s change of Rx one time only, if the new Rx is presented to us within sixty (60) days of dispensing of the eyewear in question. After 60 days or one remake any changes will be at the patient’s expense.
Contact Lenses:
Contact lenses cannot be returned for refund, but can be exchanged in the event of prescription change, provided the original boxes are unopened and not defaced in any way. In almost every case, patients are provided with trial contacts to verify the comfort and vision of the contacts. Any issues with contacts prescribed must be addressed within 30 days of the initial exam or will be considered a new exam with a new payment necessary.
Contact lenses are not a replacement for glasses, they are considered a cosmetic addition. If this is your first time with vision correction, we will not be able to fit contacts until you have worn glasses and adjusted to them. We reserve the right to decline to prescribe contacts for anyone who does not have a serviceable pair of glasses, or for whom we believe contacts would be detrimental to ocular health.
Patients will be provided a copy of their contact lens RX upon finalizing the prescription. While there are many places to order contacts, we will certainly provide you with OUR best pricing at the office. Contact prescriptions are written for 1 year or a 1 year supply, per the ABO standard. We will not honor or fill any contact orders outside of these parameters for matters of your own eye health. Purposely ordering contacts beyond the expiration date of the Rx, or of a different brand or power than prescribed jeopardizes your eye health and could expose our office to liability if we fail to stop you, requiring us to waste our time rejecting inappropriate orders. Multiple attempts to order contacts other than those currently prescribed may result in dismissal from the office.
Medical Records:
We will be happy to fax exam records to another provider at your request. We will also provide hardcopies of records at your request, but we reserve the right to require a written request. Additionally, we will require a reasonable amount of time to prepare and transmit records, which is a manual process. You should expect this could take several days. Privacy concerns preclude emailing of exam notes. We will email current, valid glasses and/or contact prescriptions at your request.
No-show/tardiness:
We value our patient’s time as well as Dr. McAlear’s time. If you no show or cancel your appointment within 24 hours twice in a row you will not be permitted to choose any prime appointment slots such as Saturdays or evenings after 3:00 PM. These slots are in high demand and we would hate to turn patients away who truly need these particular times. After more than two no shows or cancellations we reserve the right to decline to reschedule you, in which case we will forward your record to a different provider at your request.
Our office does not take walk-ins and overbooks only in cases of medical emergency. We do this to try to keep on schedule so as to respect everyone’s time. If you are not here and ready to start the exam (all forms completed in time for data entry) at 10 minutes past your appointment, we will likely need to reschedule your visit. While this may be unpopular, the alternative is inconveniencing many other patients. Patients arriving late and/or unprepared are the most common reason for us running behind schedule.
Payment:
Our office accepts cash, checks, MasterCard, Visa, American Express and Discover. Returned checks are subject to a $35.00 fee.
Patient conduct:
We expect that patients will be courteous and reasonable when they interact with our office. Threatening or abusive behavior will not be tolerated, and will result in being asked to leave the office immediately as well as dismissal from the practice. Threatening to leave negative reviews online will be considered threatening and abusive behavior. It is your right to leave reviews online as you see fit, but attempting to manipulate us by threatening poor reviews is not acceptable conduct.
(Revised 08/15/2024)