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Financial Policy

Eye Consultants of Northern Virginia, PC Financial Policy

We are committed to providing you with the highest level of service and quality care. If you have medical insurance, we will strive to help you receive your maximum allowable benefits. Ultimately, however, any and all financial liability rests with the patient.

Our office participates with most major medical insurance plans:

• We have a $50.00 no show fee if you fail to show for any scheduled appointments or cancel the same day as your appointment. Any patient who cancels a scheduled, elective surgery without giving more than five (5) business days notice prior to surgery, or does not show up for surgery, will be charged a cancellation fee of $250.00. Legitimate emergencies will be taken into consideration.

Insurance Authorization and Assignment of Benefits

I certify that the information that I have reported with regards to my insurance coverage is correct. I also authorize the release of any medical information necessary to process this claim. I also authorize payment of medical benefits to Eye Consultants of Northern Virginia, PC for medical and surgical services provided to me. I fully understand that payment for services is not contingent upon recovery and this does not relieve me of my primary obligation to pay.

Medicare Patients

In Medicare cases, Eye Consultants of Northern Virginia, PC, agrees to accept the charge determination of Medicare as the full charge, and the patient is responsible only for deductible, coinsurance and non-covered services. Coinsurance and the deductibles are based upon the charge determination of Medicare.

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Springfield/Burke Ophthalmology Office

8136 Old Keene Mill Rd, Ste. B-300
Springfield, VA 22152
(In the Cary Building)

Tel: (703) 451-6111

Fax: (703) 451-6247

Monday - Thursday: (8:30am - 5:00pm)
Friday: (8:30 - 4:00pm)

Woodbridge Ophthalmology Office

4565 Daisy Reid Ave Ste 310
Woodbridge, VA 22192

Tel: (703) 451-6111

Fax: (703) 451-6247

Monday - Thursday: (8:30am - 5:00pm)
Friday: (8:30 - 4:00pm)

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