Loock Perfect Image Eyecare, P.C.

Office Policies and Financial Agreement

Thank you for choosing Loock Perfect Image Eyecare as your eye care provider.  At Loock Perfect Image Eye Care you will find a caring team of professionals dedicated to providing high quality personalized eye care for the whole family.  Please read the following statement of our office policies and financial agreement.  We give all patients a copy of this form and require they read it prior to seeing our doctors or purchasing eyewear or contact lenses.

Vision Insurance

Vision insurance typically covers routine eye examinations and, depending on the plan, may provide benefits for glasses and/or contact lenses.  In order to assure insurance coverage is utilized properly, all patients must supply us with current insurance information, if applicable, before seeing the doctor.

•  Any Insurance co-payments or co-insurance charges are due in full on the date of service.
• We accept cash, checks, American Express, Visa, Mastercard, Discover, and CareCredit.

*  If we are an in-network provider, we are happy to bill your insurance.  It is your responsibility to pay any amount not covered by your insurance.  Your insurance policy is a contract between you (and possibly your employer) and your insurance company.  If your insurance company does not pay for rendered services or products, it is your responsibility to pay the balance in full and resolve discrepancies with your insurance company.  If you are not using insurance to cover your examination, all exam fees are due at the time of service.

Medical Exams and Medical Insurance

Medically necessary examinations (eye infection, glaucoma, dry eyes,etc) will be billed to your medical insurance provider.  Please provide our office with your most recent medical insurance card to ensure proper billing and payment.  Co-payments are due on the date of service.  We are an in-network provider for most major medical plans, but please verify our participation with your insurance carrier prior to the examination.

Returned Checks

Any check returned unpaid will result in a $20 fee PER check.  We will contact you via phone twice and if the matter is not resolved, we will send written notice.  The full balance (including any fees) must be paid within 15 days of receiving written notice.  If it is not, reporting to a collection agency and/or further legal action will be taken.  

Appointments

Any patient arriving fifteen minutes late for their scheduled appointment may be asked to reschedule his or her appointment.  Please contact our office if you are running late or need to reschedule.

If you are unable to make a scheduled appointment, it is important that you call us at (303) 471-2244 as soon as possible so we can make other arrangements.

Patients who fail to show for their appointments or who did not notify the office 24hrs in advance will be subject to a No Show/Cancellation fee of $40.

Minor Patients

The adult accompanying a minor and the parents or guardians are responsible for all fees or co-payments on the date of service.  Please make the necessary arrangements for payment if a child is to be examined without an adult present.  For unaccompanied minors, non-emergency treatment and other non- routine eye examinations will be denied unless charges have been pre-authorized by a parent or guardian.  Regarding divorce decrees and payment agreements between adults for involved minor children:  we do not split or balance bill between responsible adults.  The responsibility for payment rests with the adult accompanying the minor at the time of service.

Materials Fees

All prescription spectacles, contact lenses, and other materials require payment in full at the time of the order and will not be dispensed until the balance is paid in full. 

Prescription eyeglasses are custom orders and all purchases are non- refundable and non-returnable.  Contact lenses purchased from our office can be returned for credit or exchange IF the boxes are unopened AND unmarked.  Any boxes with writing or other marks on the box can’t be returned even if the box is unopened.  

Our office provides a prescription guarantee policy.  If you are not satisfied with your prescription, you have 90 days from the date of purchase to have the doctor re-check the prescription and re-make the glasses if necessary.  We are committed to making sure all of our patients are satisfied with their prescription and their eye wear.