Thank you for choosing the Benjamin Eye Institute as your Eye Health Care provider.
We are committed to providing you with the best possible service.
The following information is provided to ensure you are aware of and understand our practice’s financial policy.
Please ask us if you have any questions about our fees and policies and your responsibilities.
It is your responsibility to notify our office of any patient information changes (e.g. address, name change, insurance policy, etc).
Because we are an ophthalmology practice and Dr. Benjamin is a Board Certified Eye Physician and Surgeon, many health insurance plans will help you pay for the services we offer.
Because health insurance is underwritten by many different companies, we cannot tell you what your plan covers. Please read your plan’s booklet under coverage for “specialist care”.
We are preferred providers for a number of insurers, including but not limited to:
and many others.
This means that in exchange for the “preferred” status, we have agreed to accept the insurance company’s allowable reimbursement rates for covered procedures.
This does not mean that copays, co-insurance and deductibles don’t apply. They do!
Please note we had no role in deciding what your insurance covers.
Your employer decides which of our services will be covered and how much we will be paid.
You are responsible for checking your insurance coverage, deductibles, payment rates, co-payments and so forth.
Your insurance contract is between you and your company.
It is not between us and your insurance company.
You – and not your insurance company or any other person is responsible for paying the charges incurred.
COPAYS, CO-INSURANCE, & DEDUCTIBLES
Every patient is expected to present an insurance card at each visit.
All co-payments and past due balances are due at the time of your appointment.
We accept cash, checks, Visa, Mastercard, American Express, and Discover.
If you have an insurance deductible or co-insurance, any and all office visit and/or procedure charges will apply towards your deductible,
and you will be billed accordingly.
If a patient is a minor (18 years of age and below) and is using a parent's insurance
benefit, the parent or guardian must sign below.
The parent or guardian assumes responsibility for any payment due at the
MEDICAL TESTING AND PROCEDURES
Any additional testing or procedures (e.g. liquid nitrogen
"freezing" treatment or biopsies, injections, stye removals) performed are
separate, billable charges in addition to your office visit charge.
ELECTIVE/COSMETIC/REFRACTIVE/ FEES & PAYMENT
Certain services provided during your medical visit are not coverable by most insurance companies.
While these tests/procedures may be deemed necessary by you and us, they may be considered medically unnecessary by your insurance company.
It is your responsibility to understand that you may have these uninsurable fees in addition to your medical visit.
We will try our best to inform you in advance of doing any such tests or procedures. Any charges associated with these are due at the time of service.
AMBULATORY SURGICAL CENTER (ASC)
Certain surgical procedures will be performed at the outpatient facility. Dr. Benjamin operates exclusively at the Speciality Surgery Center in Beverly Hills.
Major ophthalmic surgeries, such as cataract extraction, glaucoma, lens repositioning, anterior segment surgery and vitrectomies are performed in the ASC. ASC’s are separate business entities that will bill the patient and insurers for their services.
If you receive a statement from such a facility we request that you contact them directly to resolve any billing questions.
Financial Interest Disclosure:
Physician Ownership Physician Financial Interest and Ownership:
Speciality Surgery Center in Beverly Hills is is owned, in part, by the physicians who operate there. The physician(s) who referred you to this center and who will be performing your procedure(s) may have a financial and ownership interest. Patients have the right to be treated at another health care facility of their choice. We are making this disclosure in accordance with federal regulations
Procedures performed at the ASC almost always include monitoring by anesthesia providers. The anesthesia providers bill for their services separately. If you receive a statement from an anesthesia group we request that you contact them directly to resolve any billing questions.
Most laboratory charges, such as blood work, cultures, and pathology tests, ordered through our office are billed directly to your insurance by the laboratory processing the specimen
In the case of biopsies performed in our office, the Benjamin Eye Institute will process the specimens and send them to a lab where a pathologist will make the diagnosis.
These two steps are billed independently from each other. If you receive
a statement from the pathologist laboratory, we request that you contact them directly to resolve any billing questions.
I have read and understand the above information and agree to comply with these financial policies.