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Advanced Family Eyecare, LLC – Dr. Simki Shah, OD

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Home » INSURANCE INFORMATION AND COLLECTION POLICY

INSURANCE INFORMATION AND COLLECTION POLICY

  • PRIMARY INS

  • SECONDARY INS

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  • I hereby authorize Dr. Simki Shah (Advanced Family Eyecare, LLC) to release any information acquired in the course of my examination of treatment.
    I hereby assign to Dr. Simki Shah (Advanced Family Eyecare, LLC) all money to which I am entitled for medical and/or surgical expenses, but not to exceed indebtness to Dr. Simki Shah (Advanced Family Eyecare, LLC). It is understood that any money received from my insurance company over and above my indebtness will be refunded to me when my bill is paid in full. I understand that I am financially responsible to Dr. Simki Shah (Advanced Family Eyecare, LLC) for charges not covered by this assignment.
    I understand I am responsible for any copay and deductible as per my insurance.
    We appreciate outstanding balances to be paid promptly. We will be adding 1½% interest per month for balances over 60 days and there will be a 25% surcharge for accounts referred to a collection agency.

At Advanced Family Eyecare, we are taking all precautions to provide a safe and efficient office environment for our patients and staff.

Some of the changes that have been implemented are:

* The ability to fill out all relevant office forms through a secure HIPPA compliant portal before your appointment.

* Check-in will be done remotely in your car via your phone- There will be no waiting in the office- We will have limited appointment booking to assure you will not be waiting long.

* Limited occupancy in office.

* No-touch temperature taking and COVID questionnaire of all persons entering office, including staff, twice a day.

* Masks required for all patients and staff and hand washing stations as well as hand sanitizer available throughout the office.

* Immediate initiating of testing when a patient enters the office.

* Shields for all appropriate equipment for additional protection.

* Disinfection of all rooms and items that may contact a patient after each encounter including all frames in the dispensary.

*Patients are not allowed to be accompanied by family members, with the exception of minors.