Lisa M. Nath, MD, LLC Patient Policies and Procedures

Due to increasing costs & decreasing reimbursements, the following policies had to be placed.  We thank you for understanding.   As always, we look forward to giving you the best care possible.

• Lisa M. Nath, MD, LLC will bill the insurance company/companies you have indicated that you are a member of for your visit today, provided we participate with those companies.
• Insurance cards must be presented at the time of service.  If you do not have your insurance cards with you, you will be asked to reschedule your appointment.
• It is up to you to know if you need a referral for your visit and to obtain one.  If your insurance company requires a referral for your visit and you do not have one, you will be asked to reschedule your appointment. If you are seen without a referral, you will be responsible for the entire exam charge/s.
• The patient, or the Guarantor, is responsible for any co-pays, co-insurance, deductibles or non-covered services. Non-covered services may include Refraction charges for some insurances. At this time, Medicare, Security Blue and Freedom Blue NEVER pay/cover a refraction. A refraction may be necessary at today's exam in order for Dr. Nath to make a correct diagnosis. Co-payments and non-covered services are always due at the time of service.In some instances you may also be asked to pay for any estimated co-insurance or deductibles at the time of service as well. If you do not have the funds to pay for these services, it will be up to the discretion of Lisa M. Nath, MD, LLC as to whether you will be asked to reschedule your appointment or to be billed for these charges.
• Monies collected at the time of service are applied to your account.  All services are billed to your insurance/s (providing we participate).  If your insurance company covers the services that you have already paid for, you will be sent a refund of any overpayment.  If the estimated monies we collected are less than what your insurance company allows, you will be billed for the balance.
• Physicians release & agreement:  I hereby authorize payment directly to Lisa Nath, MD of benefits due to me from my Insurance Company otherwise payable to me.  I further authorize the release of any medical information required by my Insurance carrier(s).  A copy of this authorization may be used in Lieu of the original.  I authorize the holder of medical or other information about me to release to the Social Security Administration and Health Care Financing Administration or its intermediaries or carriers any information needed for this or a related Medicare claim.  I request payment of medical insurance benefits either to myself or to the part who accepts assignment.  I understand that I am financially responsible for charges not covered by this authorization.  If I fail to pay any outstanding balances, I will also incur any charges associated with the collection of these fees.  I also understand that I will be responsible for any fees incurred because I did not provide accurate insurance information.  This includes not getting authorizations when required.
• If you are here for a contact lens evaluation, you will be asked to pay for your fit today. Once the fit is submitted to your insurance, you will be refunded if your benefit covers this service.
• When you make an appointment, it is expected that you keep it.  If you cannot keep your appointment, please give us at least 24 hours’ notice of cancellation.  Any appointments canceled under 24 hours may be subject to a $25 Cancellation Fee.  If you do not show up for a scheduled appointment and you did not call to cancel or reschedule, you will be charged a $25 No Show Fee.
• There is a $15 fee to fill out any forms.  The fee excludes PennDOT forms or medication appeals.
• All returned checks are subject to a $25 NSF fee.  We accept cash, checks, credit cards, debit cards, health savings accounts and Care Credit.  We do not accept post-dated checks.