Contact Lens Policy
Columbia
Vision Center (CVC)
Contact Lens
policy
It is our intention to provide our patients with the best possible contact lens services and
materials available.
Therefore, we are continually updating our lens inventory so that we can provide you with the
latest products in contact
lenses and solution. In order to maintain quality care, we strongly believe that providing our
patients with all pertinent
information regarding the procedures and fees relating to contact lenses before services are
rendered is in the best
interest of everyone.
We recommend a full eye exam yearly. The contact lens evaluation is NOT part of a full eye
health exam. The tests performed during
this evaluation are beyond those tests done during an eye health exam. These tests include
checking for dry eyes and allergies,and
taking other corneal measurements. The corneal-contact lens relationship is evaluated and the
proper lens power is determined while
wearing the lens.
Frequency
of contact lens fittings:
1
Every
24 months or as recommended by the doctor, even if you are not having problems with your current
contacts
2
If
patient wishes to change to a different contact lens brand after the contact lens exam is
completed
3
By
Washington State Law, the evaluation must be done within 6 months of the full eye
exam.
Fees for contact lens fitting:
1
$120
spherical contacts
2
$140
soft toric or rigid gas permeable
3
$160
bitoric, multifocal, multiple brands
4
$185-225
specialty contacts
5
$75
if we have tested for and dispensed samples but you then wish to abandon the
evaluation process
Contacts
lens follow-up:
1
If
needed, the first follow-up should be within 30 days of contact lens dispense.
2
Your
fitting period starts on your appointment date. *The contact lens evaluation fee will be
collected on this day. Insurance benefits can be used when the actual contact lens supply is
ordered.* All follow-up visits must
be completed within 2 months of this date. You will be responsible for
additional contact fitting fees (see schedule above) if more time is needed but
cannot extend past 6 months of this initial fitting.
Miscellaneous:
1
A
contact lens prescription, by Washington State Law, does not exist until the
doctor has seen the prescribed contact lenses on your eyes and deems the fit
and vision to be adequate. Please be sure to wear the contacts into the
follow-up appt.
2
By
Washington State Law, the doctor can only give out prescriptions for contacts
that have been evaluated on your eyes. No other brands or types may be substituted when
writing this prescription.
3
It
is possible for a separate medical eye condition to arise during the contact
lens fitting period. If the doctor deems this to be the case, you are
financially responsible for those office visits. We will do our best to assist
in verifying benefits under your medical insurance, if applicable.
4
You
have 2 weeks to pick up contacts after notification. After this time period,
they will be returned to the manufacturer and you will be responsible for a
restocking fee of $10.
5
Contact
lenses are non-refundable at our discretion. Fees for services are non-refundable.
General Office Policy
General
Office Policies for Columbia Vision Center
1)
Eye
examinations may be billed through vision insurance or your medical
insurance. If your exam reveals a
medical diagnosis like cataracts or dry eye syndrome, it is more appropriate to
bill your medical insurance for the exam.
You are only responsible for your copay and special testing not
covered by your insurance.
2)
If
your insurance requires a referral from your primary care provider, you are
responsible for securing this. If a
referral is not obtained, you are financially responsible for the office visit
charges.
3)
To
avoid a cancellation fee, please give 24 hours notice so that we can
accommodate other patients. The no-show
fee is $50 for all appointment types.
4)
New
glasses can take up to a month to get used to.
If you are having a problem, please let us know no later than 2 months
after you pick up your glasses so we can recheck your prescription. After this time, additional charges for the
visit and remaking the glasses may apply. There are no refunds for custom prescription lenses,
however, your lenses have a warranty.
If you cannot adapt to the prescription lenses, we offer a 1-time change to another type of lens
within 60 days. A complimentary prescription check by the doctor may be needed.
5)
If
you change your mind regarding the frame you select after your custom lenses
have been ordered for that frame, you can select a different frame under the
following conditions:
a.
You would pay
the difference in the
new and old frame price. However, no refund will be given.
b.
There is a
$100 charge for the cost
of your new custom progressive, bifocal, or trifocal lenses or
c.
There is a
$50 charge for the cost of
your new custom single vision lenses.
6)
Our
frames and lenses have a one year warranty against defects (some sale frames do
not have a warranty). There is a $20
shipping and handling fee for each frame/part or pair of lenses, if needed.
7)
All
sale frames are final sale. Clearance frames have no warranty.
8)
The
return policy for non-prescription sunglasses, over-the-counter readers, and
other optical accessories is 7 days for refund or exchange and must be in new
condition.
9)
Please turn
off phones during the eye exam.
Thank you!
I have read and understand the General Office Policy for Columbia
Vision Center.
Notice of Privacy Practices
This notice describes how medical
information about you may be used and disclosed and how you can get access to this information.
Please read it carefully.
THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Your health record contains personal
information about you and your health. This information about you that may identify you and that
relates to your past, present or future physical or mental health or condition and related health
care services is referred to as Protected Health Information ("PHI"). This Notice of Privacy
Practices describes how we may use and disclose your PHI in accordance with applicable law,
including the Health Insurance Portability and Accountability Act ("HIPAA"), regulations promulgated
under HIPAA including the HIPAA Privacy and Security Rules, and the NASW Code of Ethics. It also
describes your rights regarding how you may gain access to and control your PHI.
We are required by law to maintain the
privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect
to PHI. We are required to abide by the terms of this Notice of Privacy Practices. We reserve the
right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy
Practices will be effective for all PHI that we maintain at that time. We will provide you with a
copy of the revised Notice of Privacy Practices by posting a copy on our website, sending a copy to
you in the mail upon request or providing one to you at your next appointment.
HOW WE MAY USE AND DISCLOSE HEALTH
INFORMATION ABOUT YOU
For Treatment. Your PHI may be
used and disclosed by those who are involved in your care for the purpose of providing,
coordinating, or managing your health care treatment and related services. This includes
consultation with clinical supervisors or other treatment team members. We may disclose PHI to any
other consultant only with your authorization.
For Payment. We may use and
disclose PHI so that we can receive payment for the treatment services provided to you. This will
only be done with your authorization. Examples of payment-related activities are: making a
determination of eligibility or coverage for insurance benefits, processing claims with your
insurance company, reviewing services provided to you to determine medical necessity, or undertaking
utilization review activities. If it becomes necessary to use collection processes due to lack of
payment for services, we will only disclose the minimum amount of PHI necessary for purposes of
collection.
For Health Care Operations. We
may use or disclose, as needed, your PHI in order to support our business activities including, but
not limited to, quality assessment activities, employee review activities, licensing, and conducting
or arranging for other business activities. For example, we may share your PHI with third parties
that perform various business activities (e.g., billing or typing services) provided we have a
written contract with the business that requires it to safeguard the privacy of your PHI. For
training or teaching purposes PHI will be disclosed only with your authorization.
Required by Law. Under the law,
we must disclose your PHI to you upon your request. In addition, we must make disclosures to the
Secretary of the Department of Health and Human Services for the purpose of investigating or
determining our compliance with the requirements of the Privacy Rule.
Without Authorization.
Following is a list of the categories of uses and disclosures permitted by HIPAA without an
authorization. Applicable law and ethical standards permit us to disclose information about you
without your authorization only in a limited number of situations.
Child Abuse or Neglect. We may
disclose your PHI to a state or local agency that is authorized by law to receive reports of child
abuse or neglect.
Judicial and Administrative
Proceedings. We may disclose your PHI pursuant to a subpoena (with your written consent),
court order, administrative order or similar process.
Deceased Patients. We may
disclose PHI regarding deceased patients as mandated by state law, or to a family member or friend
that was involved in your care or payment for care prior to death, based on your prior consent. A
release of information regarding deceased patients may be limited to an executor or administrator of
a deceased person's estate or the person identified as next-of-kin. PHI of persons that have been
deceased for more than fifty (50) years is not protected under HIPAA.
Medical Emergencies. We may use
or disclose your PHI in a medical emergency situation to medical personnel only in order to prevent
serious harm. Our staff will try to provide you a copy of this notice as soon as reasonably
practicable after the resolution of the emergency.
Family Involvement in Care. We
may disclose information to close family members or friends directly involved in your treatment
based on your consent or as necessary to prevent serious harm.
Health Oversight. If required,
we may disclose PHI to a health oversight agency for activities authorized by law, such as audits,
investigations, and inspections. Oversight agencies seeking this information include government
agencies and organizations that provide financial assistance to the program (such as third-party
payors based on your prior consent) and peer review organizations performing utilization and quality
control.
Law Enforcement. We may
disclose PHI to a law enforcement official as required by law, in compliance with a subpoena (with
your written consent), court order, administrative order or similar document, for the purpose of
identifying a suspect, material witness or missing person, in connection with the victim of a crime,
in connection with a deceased person, in connection with the reporting of a crime in an emergency,
or in connection with a crime on the premises.
Specialized Government
Functions. We may review requests from U.S. military command authorities if you have served
as a member of the armed forces, authorized officials for national security and intelligence reasons
and to the Department of State for medical suitability determinations, and disclose your PHI based
on your written consent, mandatory disclosure laws and the need to prevent serious harm.
Public Health. If required, we
may use or disclose your PHI for mandatory public health activities to a public health authority
authorized by law to collect or receive such information for the purpose of preventing or
controlling disease, injury, or disability, or if directed by a public health authority, to a
government agency that is collaborating with that public health authority.
Public Safety. We may disclose
your PHI if necessary to prevent or lessen a serious and imminent threat to the health or safety of
a person or the public. If information is disclosed to prevent or lessen a serious threat it will be
disclosed to a person or persons reasonably able to prevent or lessen the threat, including the
target of the threat.
Research. PHI may only be
disclosed after a special approval process or with your authorization.
Fundraising. We may send you
fundraising communications at one time or another. You have the right to opt out of such fundraising
communications with each solicitation you receive.
Verbal Permission. We may also
use or disclose your information to family members that are directly involved in your treatment with
your verbal permission.
With Authorization.
We must obtain your written
authorization for any use or disclosure of protected health information that is not for treatment,
payment or health care operations or otherwise permitted or required by the Privacy Rule. Your
authorization should contain specific information regarding the information to be disclosed or used,
the person(s) disclosing and receiving the information, expiration, right to revoke in writing, and
other data. The following uses and disclosures will be made only with your written authorization:
(i) most uses and disclosures of psychotherapy notes which are separated from the rest of your
medical record; (ii) most uses and disclosures of PHI for marketing purposes, including subsidized
treatment communications; (iii) disclosures that constitute a sale of PHI; and (iv) other uses and
disclosures not described in this Notice of Privacy Practices.
YOUR RIGHTS REGARDING YOUR PHI
You have the following rights
regarding PHI we maintain about you. To exercise any of these rights, please submit your request in
writing to our Privacy Officer Dr. Jean Hua or email to Drhua@columbiavision.com
- Right of Access to Inspect and Copy. You have the right, which may be restricted only in
exceptional circumstances, to inspect and copy PHI that is maintained in a "designated record
set". A designated record set contains mental health/medical and billing records and any other
records that are used to make decisions about your care. Your right to inspect and copy PHI will
be restricted only in those situations where there is compelling evidence that access would
cause serious harm to you or if the information is contained in separately maintained
psychotherapy notes. We may charge a reasonable, cost-based fee for copies. If your records are
maintained electronically, you may also request an electronic copy of your PHI. You may also
request that a copy of your PHI be provided to another person.
- Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete,
you may ask us to amend the information although we are not required to agree to the amendment.
If we deny your request for amendment, you have the right to file a statement of disagreement
with us. We may prepare a rebuttal to your statement and will provide you with a copy. Please
contact the Privacy Officer if you have any questions.
- Right to an Accounting of Disclosures. You have the right to request an accounting of
certain of the disclosures that we make of your PHI. We may charge you a reasonable fee if you
request more than one accounting in any 12-month period.
- Right to Request Restrictions. You have the right to request a restriction or limitation
on the use or disclosure of your PHI for treatment, payment, or health care operations. We are
not required to agree to your request unless the request is to restrict disclosure of PHI to a
health plan for purposes of carrying out payment or health care operations, and the PHI pertains
to a health care item or service that you paid for out of pocket. In that case, we are required
to honor your request for a restriction.
- Right to Request Confidential Communication. You have the right to request that we
communicate with you about health matters in a certain way or at a certain location. We will
accommodate reasonable requests. We may require information regarding how payment will be
handled or specification of an alternative address or other method of contact as a condition for
accommodating your request. We will not ask you for an explanation of why you are making the
request.
- Breach Notification. If there is a breach of your PHI, we will notify you of this breach,
including what happened and what you can do to protect yourself. We will also notify the
Secretary of Health and Human Services.
- Right to a Copy of this Notice. You have the right to a copy of this notice.
COMPLAINTS
If you believe we have violated your
privacy rights, you have the right to file a complaint in writing with our Privacy Officer Dr. Jean
Hua at Columbia Vision Center, (206) 382-6682, or in writing with the Secretary of Health and Human
Services at 200 Independence Avenue, S.W. Washington, D.C. 20201. We will not retaliate against you
for filing a complaint.
I have read and understand the Notice of Privacy Practices for
Columbia Vision Center.