Maryland Eye Institute has carefully selected the brands of contact lenses that we offer to our patients. The health of your eyes is our primary concern so we use quality lenses supplied from selected group of manufacturers. We are able to offer competitive pricing to our patients since we have an established working relationship with the suppliers. Maryland Eye I nstitute will send the contacts to you if you prefer to have them shipped directly to you at no additional cost if you order a year supply of disposable contacts. You have the option to come and pick them up from the office also. An initial fitting is necessary for the proper dispensing of all the contact lenses. We encourage all of our contact lens patients to have an annual eye examination after your initial fitting.

Included with the initial contact lens exam:
• A contact lens examination includes a refraction (eyeglass prescription).
• All measurements to ensure that the lenses properly fit the corneas of your eyes.
• Trial lenses to determine proper vision, fit, and comfort.
• Instructions on how to insert a care for your contact lenses.
• New contact lens users will receive a starter lens solution kit.

Contact Lens Agreement:
Contact Lens prices may vary depending on patient's specific needs. Contact lenses are medical devices that may have certain health implications if not prescribed correctly. Your doctor must invest additional time and expertise to determine which contact lenses are in your best vision and health interests, therefore additional fees may apply for this service.

Accepted Insurance Policy
• Dr. Naseh is an in-network provider within most major insurance plans. Please refer to end of this page to be directed to you insurance providers' website. If you do not see your insurance provider listed, please contact them to verify eye care coverage.
• Patients must have paid their deductibles or plan to pay at the time of the office visit.
• All appropriate co-pays are due at the time of service. If we must bill you for co-pay, there will be a $25 processing fee.
• Selected HMO's are accepted. It is mandatory that you have a referral from your primary care physician.
• A $35 refractive charge is due at the time of service for routine eye exams and Medicare patients. This charge is not billable to insurance.

Billing and Payment Policy:
• There is a $75 cancellation fee if the patient cancels his/her appointment in less than 24 hrs. timeframe.
For weekend cancellations only, please call (301) 840-2209.

• There is a $75 refraction fee for Rx Print.
What is a refraction fee?
A refraction is the test that is performed to determine your eyeglass prescription. A refraction may be performed by either the doctor or a technician, and typically involves questioning along the lines of, "Is 1 better than 2?" Medicare and many other insurance plans consider a refraction to be routine medical care not covered under their medical coverage, so this amount is charged separately and is paid directly by the patient. Medicare secondary insurance plans will also not pay the charge since it is not a Medicare-covered service, so the $75.00 fee is to be paid by the patient.

• We file an insurance claim within 7 days of your date of service.
• If we do not receive a response from your insurance carrier within 61-90 days, you will receive a statement and will need to contact your insurance carrier regarding payment. The balance due for medical services will be your responsibility.
• A billing statement covering medical services rendered will be mailed to you on a monthly basis.
• After 6 months from the original date a claim has been filed, we place accounts with a collection agency. Patients are then responsible for any collection costs. If you had a previous collection balance or are presently in collection, the physician may use his or her discretion as to seeing you again. It may be required that you pay your previous balance in full prior to being seen. You will be responsible for payment of the office visits, co-pay, deductible, etc., on the day of the visit.

If you have a financial problem, please ask to discuss a payment plan with our billing department. We accept cash, checks, VISA, American Express, MasterCard and Discovery as payment methods. In the event a personal check is returned unpaid from your bank, your account will be charged a $40 returned check fee.

MINOR PATIENTS:
The parent/guardian/adult must accompany a minor or the child cannot be seen. The parent/guardian/adult accompanying a minor child is responsible for payment. Any child 18 or over is legally an adult and responsible for his/her bill, regardless of attending college, living at home, or being covered by parents insurance. If both parents have insurance, the parent with the first birthday in the year is most often the primary insurer. Please check your insurance policy to determine which company is primary before your appointment. In divorce cases, the parent who brings the child in for services is ultimately the responsible party.

POLICY FOR HEARING DISABLED AND OTHER DISABILITIES:
Please be informed that we will arrange necessary auxiliary aid and services accommodations for every hearing impaired patient and disabled patients. This accommodations take at least 3 days to arrange, so please inform Maryland Eye Institute ahead of time that you will need accommodations during your eye exam. We will gladly offer auxiliary aid and service to each patient with Hearing Impairment and other disabilities. Please ask for accommodations before you make your next appointment

CANCELLATION POLICY: We have a cancellation policy when canceling or rescheduling an appointment. Because your services are guaranteed reservations reserved for you, a $75 non-refundable charge will be assessed for the following conditions:
• Less than 24-hour notification to cancel or reschedule an appointment.
• No show or missed appointments.

LATE ARRIVALS:
We will always try and honor your appointment time needs, but please keep in mind that if you arrive late for a service it may require us to shorten the length of the treatment or reschedule your treatment. We will do our best if possible to treat you on the same day, as close to your original scheduled time.

CHILDREN POLICY:
No children or siblings can accompany a patient during his/her visit. Underage patients can enter the exam room with one adult only!

EYEWEAR POLICY:
We only offer a 30-day limited warranty for eyewear purchased from our Optical Boutique





Office Hours
Monday 8:00-5:00
Tuesday 8:00-5:00
Wednesday 8:00-5:00
Thursday 8:00-5:00
Friday 8:00-5:00
Saturday Closed
Sunday Closed
Maryland Eye Institute
6 Montgomery Village Ave.
Suite 103
Gaithersburg, MD 20879
(301) 840-2208
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Maryland Eye Institute 6 Montgomery Village Ave. Suite 103 Gaithersburg, MD 20879 Phone: (301) 840-2208 Fax: (301) 840-2210

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