1. Insurance – Capital Eye Care/Hill Country Eye Care will file claims of all applicable visits and procedures. You are responsible for payment of all deductibles, co-insurance, and all non-covered services. Remember that insurance coverage is a contract between the patient and the insurance company. The patient is responsible for providing Capital Eye Care/Hill Country Eye Care with current and valid medical insurance. The ultimate responsibility for payment rests with you.

2. Referrals and Pre-Authorizations – You are required to 1.) know whether your insurance requires a referral for medical and 2.) obtain that referral before you are scheduled to see our physicians. Our office will assist you in determining whether our doctors are participating or non-participating providers. However, this is not a guarantee of coverage. Our office will not see a patient who does not have a valid referral.

3. No Insurance – Patients who do not have insurance are expected to pay in full on the day that services are rendered. We accept payment with cash, check, or credit card (Discover/MasterCard/Visa). We understand that individual situations may make it difficult to meet these financial obligations and we are happy to discuss other payment arrangements as needed.

4. Returned Checks – Your account will be charged $50 for a returned check. You will be asked to provide payment by cash or credit card for the total cost of the returned check and $50 fee.

5. Past Due Accounts – A finance charge of 1.5% per month is assessed on all accounts not paid within 30 days. Patients who have not tried to make payment arrangements or have not met their financial obligation will be turned over to a collection agency. Once an account has been sent to collections, the patient must contact the collection agency for all correspondence regarding the balance.

6. Refunds – Any refund due to the patient will be given only after all insurance claims are processed. Refunds above $50.00 will be issued to the patient via mailed check; anything under $50.00 will be kept on the account for future use or can be given to the patient upon patient request.

7. Non-Covered Services – Hill Country Eye Care will try to inform you if we believe a service may not be covered by your insurance company. You will be expected to pay for such services if your insurance company denies payment. Some medical insurance plans do NOT cover routine eye exams, and most patients do not qualify for routine visits because a medical diagnosis is found. If there is not a medical diagnosis, then the exam will be coded as routine, and you will be responsible for any charges not covered by your medical insurance.

8. Appointment Cancellations and No-Shows -- If you need to cancel or reschedule your appointment, please give our office at least

24 hours’ notice of your scheduled appointment. Failure to give proper notice of cancellation or failure to show for your appointment may result in a charge to your account of $30.