Back Financial Policy Back

Thank you for choosing us as your health care provider! We are committed to provide the highest quality care and treatment for you. Please understand that payment of your bill is considered a part of your partnership in treatment. We require you to read and agree to this Financial Policy Statement. All patients must complete our information and insurance forms before being seen. Full payment for services and/or co-insurance payment is due at the time of service. We accept cash, checks, VISA / MASTERCARD, or DISCOVER cards. For Large amounts and with approved credit, Pulse Care may be another payment option.

  • Regarding Insurance
    We may accept assignment of insurance benefits if we are a participating provider. Any remaining balance is your responsibility. In order for us to bill your insurance company, you must give us current and correct insurance information. Your insurance policy is a contract between you and your insurance company only. AVSC is not party to that contract. Please be aware that some, and perhaps all of the services we provide may be non-covered services and may not be considered reasonable and/or necessary under your health insurance policy even though we do. If we are a participating provider, all co-pays are due prior to treatment. If your insurance company does not pay all amounts due, you are still obligated and responsible to pay full amount charged. Since there are a multitude of policies, you are ultimately responsible for knowing and determining your insurance company's eligibility criteria, coverage amounts and deductibles, and compelling your insurance company to pay.  We will bill one insurance company one time as a courtesy, thereafter additional fees will apply if rebilling is required, or your insurance company requires additional information. Follow up of your insurance claim is your responsibility. AVSC is committed to providing the best treatment for our patients and we charge what is usual and customary for our area. You are responsible for payment regardless of any insurance company's arbitrary determination of usual and customary rates reasonableness and necessity.

  • Regarding Privacy
    Because new Federal and Insurance regulations govern how patient confidentiality is protected, we require specific written and signed consents and/or authorizations from you before we can communicate any patient information to third parties. After we receive a written  request form you, all information releases will be in writing to you alone (see the HIPAA regulations link on our front page "Notice of privacy Practices")

  • Collections and Billing
    1. Our billing cycle occurs at the end of each month and you will receive a statement of your account.
    2. a $25.00 rebilling fee will be added to any account, if it is necessary to submit a bill to a patient; this is simply to cover our costs (postage, employee time, etc.) incurred in billing.
    3. In order for us to provide the highest quality if care and because some patients unfortunately have not been responsible about paying their fees, if an account has been billed for three months without payment, the account is turned over to collections.
    4. Any overdue account that is turned over to collections, will be charged an additional 33.3% to cover collection costs.
    5. We will not intentionally turn any account over to collections if the patient is cooperating and making an effort to keep their account current.
    6. If you think there has been an error on your account you must notify us in writing within thirty days of it's posting and we will make every effort to correct the situation.
    7. Returned check fees are $35.00. Accounts ninety days past dues are automatically forwarded for collection action. All collection fees, attorney fees, cost of services, and court costs will also be assessed.
  • Your Responsibility
    By proceeding to enter and submit information to AVSC from this website, you declare your responsibility for, and authorize treatment of the persons named herein. You agree to pay all fees and charges for such treatment. We must emphasize that our primary mission is to deliver medical care - not financial advise. Our relations therefore is solely with you, not your insurance company nor former spouse. Further, the person being seen by the doctor (the patient), or, if the patient is a minor, then that adult person bringing in the child, is ultimately responsible for all charges for professional services rendered and/or materials used to care for that patient. The parent or guardian bringing the minor to this office is responsible for full payment. For unaccompanied minors, non-emergency treatment cannot be delivered unless written consent for treatment has been given and charges have been pre-authorized to a VISA / MASTERCARD or DISCOVER card, or payment of cash or check at the time service is made.
  • Missed Appointments
    Please help us to serve you by keeping scheduled appointments. If you will be unable to keep your scheduled appointment, you must cancel it on the preceding day. If an appointment is missed and not cancelled by the preceding day, we will charge $30.00 per thirty minute appointment.
  • Medical Records Release and Statement of Understanding
    By proceeding to submit any informational or contractual information from this website I declare that i have read and agree to the terms and conditions set forth above. I further agree to pay all fees and charges for treatment and materials the day services are rendered. I certify that my personal history and personal information are correct and I consent to the release of mediacal information to third party payors
  • Your Rights as a Patient
    You have the right to restrict the disclosure of your protected health information (in writing). The request for restriction may be denied if the information is required for treatment, payment or health care operations. -You have the right to receive confidential communications regarding your protected health information. -You have the right to inspect and copy your protected health information. -You have the right to amend your protected health information. -You have the right to receive an account of disclosures of your protected health information. -You have the right to a paper copy of this notice of privacy practices.
  • Legal Requirements
    Academy Vision Science Clinic is required by law to maintain the privacy of your protected health information. We are required to abide by the terms of this notice as it is currently stated, and reserve the right to change this notice. The policies in any new notice will not be in effect until they are posted to this site, or are available within our office. Although we have gone to great lengths and expense to protect any information entered and submitted by you, or an agent or representative, to, and through this website, we cannot guarantee against any security breech that may include, but not be limited to any information that you volunteer.
  • Contact Information
    For further information about Academy Vision Science Clinic' Financial Policies, please contact Academy Vision Science Clinic at the following address or phone number: Academy Vision Science Clinic  - 5525 N. Union Blvd, Colorado Springs, CO. 80918-1969 Tel: (719) 598-6000 Fax: (719) 592-0616      Email
    		•
    Back Top  Financial Policy  Top Back
      .