Information Regarding Insurance Coverage

Phone: <a class="ecp-phone-call-phone" href="tel:201-288-1109" style="text-decoration:none"> 201-288-1109
Email: heightseyecenter227@gmail.com (Do not send personal health information by email.)

Name: Heights Eye Center
Address: 227 1/2 Boulevard, Hasbrouck Heights, NJ, 07604, US
Telephone: 201-288-1109
Price range: $000 - $300

Dr. James Aversa Optometric Physician 227 2 Boulevard Hasbrouck Heights, NJ 07604 (201) 288-1109

Health care is changing rapidly, and we have all had to adapt to these changes. We are providing the following information to help reduce confusion about our fees and your responsibilities.

If you will be using an Insurance plan or Optical Benefit for your eye examination, please let us know before services are rendered.
REFERRALS
It is the patient’s responsibility to determine whether your health plan requires a referral from your Primary Care Provider for your visit.

ROUTINE EYE EXAMS
It is the patient’s responsibility to know if you are covered for a Routine Eye Examination. Some medical insurance plansor optical plans will cover a routine eye exam. Most Routine eye examinations do not result in a medical diagnosis.

MEDICAL VISITS
Medical insurance plans will cover any medical visit and most procedures. Medical insurance plans require a medical diagnosis. Optical plans do not cover medical visits. Refractions are not covered by medical plans.

CONTACT LENSES
Contact Lens Evaluations & Fittings are not covered by Routine eye examinations. Some Vision Service Plans may have an Optical Allowance towards Contact Lenses.
Patients are responsible for any Co-payments, Deductibles, Co-Insurance and all Services deemed to be non-covered by your plan.
ACKNOWLEDGEMENT OF RECEIPT — HEIGHTS EYE CENTER
I acknowledge that I received a copy of James Aversa, O.D., Notice of Privacy Practices.
I have read and understand the above information.
Name*
First Last
Date*
MM slash DD slash YYYY
Signature*

ACKNOWLEDGEMENT OF RECEIPT — HEIGHTS EYE CENTER

Heights Eye Center