Financial Arrangements
Longview Eye and Vision will bill your insurance as a courtesy if compete insurance information is provided. In order to submit a claim to your insurance company we will need authorization to release medical information to your insurance company.
I authorize any medical information necessary to process my claims and request payment be issued to Longview Eye and Vision. I understand that if my insurance does not pay I am responsible for the bill. I also understand that if I carry no insurance I am responsible for the whole bill at time of service.
A service charge of 1.00% per month will be added after 60 days. This is an APR of 12.00%. Our minimum service charge is $1.00. All NSF checks are subject to a fee of $35.00. Any account going to the collection process will be assessed a fee of $35.00. In the even legal action should become necessary to collect any unpaid balance due to medical services rendered to me or my family, I/we agree to pay reasonable attorney fees or other such costs as the court determines proper. I agree that the venue for any legal action shall be in Cowlitz County.
To avoid misunderstandings, we are always happy to discuss questions you have regarding our financial policies.
PLELASE NOTE: A DEPOSIT OF HALF THE TOTAL FEE IS REQUIRED TO ORDER MATERIALS, THE OTHER HALF IS DUE UPON DELIVERY.