Office Policies

 

PRIVACY POLICY
•    Privacy Policy:  In the course of providing service to you, we create, receive and store health information that identifies you. It is often necessary to use and disclose this health information in order to treat you, to obtain payment for our services and to conduct health care operations involving our office.

•    The Notice of Privacy Practices you have been given describes these uses and disclosures in detail. You are free to refer to this notice at any time before you sign this form. As described in our Notice of Privacy Practices, the use and disclosure of your health information for treatment purposes not only includes care and service provided here, but also disclosures of your health information as may be necessary or appropriate for you to receive follow-up care from another health professional. Similarly, the use and disclosure of your health information for purposes of payment includes 
   (1) our submission of your health information to a billing agent or vendor for processing claims or obtaining payment; 
   (2) our submission of claims to third-party payers or insurers for claims review, determination of benefits and payment; 
   (3) our submission of your health information to auditors hired by third-party payers and insurers; 
   (4) other aspects of payment described in our Notice of Privacy Practices.  Our Notice of Privacy Practices will be updated whenever our privacy practices change.   

•    Updated Privacy Policy:  You may receive an updated copy of our privacy policy at our office or review it on our website www.partridgeoptometry.com

When you sign this consent document, you signify that you agree that we can and will use and disclose your health information to treat you, to obtain payment for our services and to perform healthcare operations. You also signify that you have received a copy of our Notice of Privacy Practices.

You have the right to ask us to restrict the uses or disclosures made for purposes of treatment, payment or healthcare operations, but as described in our Notice of Privacy Practices, we are not obliged to agree to these suggested restrictions. If we do agree, however, the restrictions are binding on us. Our Notice of Privacy Practices describes how to ask for a restriction. 

I have read this document and understand it.   I consent to the use and disclosure of my health information for purposes of treatment, payment, and healthcare operations. I acknowledge that I have received the Notice of Privacy Practices from Dr. Jarom B. Partridge, O.D. Inc

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REPAIRS AND MAINTENANCE:

We will service repairs to glasses at no charge provided the eyewear was purchased at our office. 
•    Lab Repairs:  Any repairs sent to the lab will be charged accordingly.
•    Frame warranties:  Frame warranties do not cover normal wear and tear, breakage, loss, etc. In the event a frame is discontinued, we will offer a 50% discount on a new frame for non-insurance billed replacement.
•    Non-Office Purchased Glasses (Patient’s own frame):  Glasses purchased outside our office will be serviced and charged accordingly. We recommend frames purchased at another location be serviced through that provider as we are not responsible and/or liable for replacement should breakage occur.
•    Original Lenses:  Your original lenses will be handled as carefully as possible, but we are not responsible for damage or loss during the manufacturing process.
•    Frame Refund:  If you request to cancel an order, a 50% non-refundable frame cancellation fee will apply unless cancelled within 1 business day.
•    Progressive Lens:  Costs associated to with upgrading progressive lenses is non-refundable. First-time progressive lens wearers who are unable to adapt will be given the option to replace lenses with lined bifocals or single vision lenses at no additional cost.
•    Special Order Frames:  If you request a special order (out of stock) frame to view, no charge will be incurred on the first frame. Additional frames will incur a $20 restocking fee should you choose not to purchase it.

PATIENT OWN FRAME:  We pledge to take the utmost care in handling your eyeglasses and are happy to process new lenses for your own frame. The use of your own frame is at your own risk.  Often times, it is very difficult to surmise the condition of the frame material and whether it is likely to break or be damaged.  There is a small possibility that your frame may be damaged or lost during the manufacturing process. The lab and our office cannot be responsible for replacement or reimbursement.
•    Breakage:  If your frame breaks during the new lens insertion process, the lenses made for your frame cannot be placed into a different style frame. We will make new lenses at no charge for a new frame, but the cost of the replacement frame is your responsibility.
•    Original Lenses:  Your original lenses will be handled as carefully as possible, but we are not responsible for damage or loss during the manufacturing process.

 

FINANCIAL POLICIES:
•    Insurance:  We are a participating provider with VSP (Vision Service Plan), EyeMed, and BlueCross Vision Care Plans, Medicare and Spectera. We do not MediCal.
•    Patients with Insurance:  Some insurance plans will not pay for all services or materials that are received.  Therefore, services or materials that are not covered by or paid for by your insurance company will be your financial responsibility.
•    Co-Pay:  Co-Payments are due on the same day services are rendered
•    Ordering Deposit:  A minimum 50% deposit is required prior to processing prescription glasses and/or contacts.  The remaining balance is required to be paid-in-full prior to the release of materials
•    Outstanding Balance:  All outstanding balances will be sent to a collection agency after 90 days.  Fees incurred by the engagement of the collection agency (33% of the outstanding debt) will be added to the outstanding balance.  

LAB POLICIES & REFUNDS:
•    Frame Warranty:  Most New frames have a 1-year warranty from the original order date for manufacturer defects only.  New Tom Davies frames have a 2-year warranty.    
•    Frame warranties do not cover normal wear and tear, breakage, loss, etc. In the event a frame is discontinued, we will offer a 50% discount on a new frame for non-insurance billed replacement.
•    Frame Refund:  If you request to cancel an order, a 50% non-refundable frame cancellation fee will apply unless canceled within 1 business day.
•    Progressive Lens:  Costs associated with upgrading progressive lenses is non-refundable.  Progressive lens wearers who are unable to adapt will be given the option to replace lenses with lined bifocals or single vision lenses at no additional cost.
 

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PRESCRIPTION CHANGES:
If the patient is unable to adapt to his/her new prescription, the lab will re-do lenses with a new prescription (in the original frame) within a 30-day period. All prescriptions made through an outside source will be charged $30.00 for prescription verification (if the patient requests a prescription check with our office).

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CONTACT LENS POLICIES
•    Fees:  Contact lens services start at $89 for existing patients and $114 for new patients.
•    This includes initial fitting, training (for new wearers), and follow-up visits.  Pricing is based upon lens type and complexity of the exam.
•    Contact lens service fees are to be paid in full on the date of service and are not refundable.
•    Contact lens services are not included under your exam co-pay.
•    Insurance may not cover contact lens fitting/follow-up services in full.  Non-covered services are the patient’s responsibility.  
•    Prescriptions:  Contact lens prescriptions will only be released after an initial fitting period is successfully completed (exam, fitting, and follow-up visits) and all fees are paid.
•    Contact lens prescriptions are valid for one year from the date of finalization.
•    Contact lens prescriptions must be finalized within 30 days or you may be subject to an additional exam fee.
•    Contact lens prescriptions are valid for 12 months.  Prescription is for 12 month supply and once 12-month supply has been ordered, prescription will not be permitted to be used for additional contact lens orders.  Prescription must be valid/renewed to order contact lenses.  
•    Contact lens return/exchange:  All boxes must be unopened, unmarked, and in good condition.  A restocking fee may apply. 
•    Unopened boxes must be returned within 30 days from exam date.
•    Only contacts purchased through our office may be returned for refund or exchange.

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