Welcome to Mudgil Eye Associates
In order to facilitate your first visit and minimize your wait time, please download the NEW PATIENT FORMS below (RETURN PATIENT FORMS- if not been seen in over two years), and bring the completed forms on the day of your visit. Please also remember to bring your insurance cards. We are a specialist office and will bill your medical insurance. We do not participate with any vision plans. We accept cash, checks, or credit cards for co-payments, co-insurance or deductible, which will be collected at the time of visit. We provide a good faith estimate for our self pay patients, upon request.
Card on File: We require a credit card on file (HSA, VISA, Mastercard or Discover) in order to be seen. This provides a convenient and secure way of payment for outstanding balance on your account once your claim has been processed by your insurance carrier, and the insurance portion of the claim has been posted to the account, or in the event that valid insurance information was not provided at the time of service. You will always receive a statement, and have 20 days to respond, before we charge your card.
Patient Forms:
- NEW PATIENT FORMS
- RETURN PATIENT FORMS (not seen in over two years)
- Release of Medical Records.
Referrals: If you have an HMO insurance that requires a referral (such as Keystone Health Plan East, Aetna HMO, Tricare Prime, or other HMO), the referral MUST be called in by your primary care doctor to our office PRIOR to the visit. Otherwise, you will be responsible for the cost of the visit. Obtaining a referral is the patients responsibility.
Cancellations: Please make cancellations at least 24 hours prior to the scheduled appointment to avoid a $72 late cancellation /no show charge. After two no shows/ late cancellations within a 12 month period, we will no longer be able to see you at our practice.
Completion o f Medical Forms: Forms are will be considered for completion only if we have seen you in the last year. We will require a minimum of 7 days notice. The charge for completion of the form will depend on the length and detail necessary. If form is brought on the day of the visit there will be no charge. All other form completion requests outside the day of visit there is a minimum $10 charge. Expited forms will be a minimum of $25. There is a possibility that upon review of the form, you may be asked to come in for an exam in order for us to complete the submitted form.
After Hour Phone Calls: If we have not seen you in the last 7 days and you would like the doctor to discuss your eye condition we may bill your insurance for the phone call with you. Alternatively, you are welcome to come in and be seen and discuss.
Deductibles, Coinsurances, and/or Copays: Deductibles, coinsurances, and/or copays are due at the time of the service. There will be a $15 processing charge if they are not paid at the time of the service. We accept cash, checks, Visa, Mastercard, or Discover as forms of payment.
