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10360 Melody Dr., Northglenn, CO 80260 View Location

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NGOC Financial Policy


Financial Policy and Patient Responsibility
Updated 11/18/2016

Thank you for choosing Northglenn Optometric Center as your local vision provider. We are committed to providing you with quality and affordable health care. Below you will find our updated Financial Policy regarding patient and insurance responsibility for services rendered. Please read through it, ask us any questions you may have, and sign in the space provided. A copy will be provided to you upon request.

1. Insurance. We participate in most insurance plans, including Medicare. If you are not insured by a plan we do business with, payment in full is expected at the time of service. If you are insured by a plan we do business with but don’t have an up-to-date insurance card, payment in full for each visit is required until we can verify your coverage. We are able to pull your insurance as a courtesy on request. However knowing your insurance benefits, including in and out of network benefits, is ultimately the patient’s responsibility. Please contact your insurance company with any questions you may have regarding your coverage.

2. Co-Payments and Deductibles. All co-payments and deductibles must be paid at the time of service. This arrangement is part of your contract with your insurance company. Failure on our part to collect co-payments and deductibles from patients can be considered fraud. Please help us in upholding the law by paying your co-payment at each visit.

3. Non-Covered Services. Please be aware that some – and perhaps all – of the services you receive may be non-covered or not considered reasonable or necessary by Medicare or other insurers. You must pay for these services in full at the time of visit.

4. Proof of Insurance. All patients must complete our patient information form before seeing the doctor. We must obtain a copy of your driver’s license and current valid insurance card to provide proof of insurance. If you fail to provide us with the correct insurance information in a timely manner, you may be responsible for the balance of a claim.

5. Quote of Benefits. When using your insurance to purchase glasses or contact lenses the amount the optician or staff member gives is a quote of benefits. If after billing your insurance there is a remaining balance you are required to pay the difference. The balance of the claim is ultimately your responsibility.

6. Claims Submission. We will submit your claims and assist you in any way we reasonably can to help get your claims paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the balance of your claim is your responsibility whether or not your insurance company pays your claim. Your insurance benefit is a contract between you and your insurance company; we are not party to that contract.

7. Coverage changes. If your insurance changes please notify us before your next visit so we can make the appropriate changes to help you receive your maximum benefits. If your insurance company does not pay your claim in 90 days, the balance will automatically be billed to you.


8. Secondary Insurance. Not all vision plans and insurance can be coordinated. It will depend on the plan and/or services rendered. If you have any questions about whether you will able to use multiple insurances please call your insurance company.

9. Statements. Northglenn Optometric Center sends out statements monthly. If there is a balance or credit after billing insurance we will mail you a statement. If payment is not received before the 3rd statement you will be charged a $10 late fee. For credits we must use the same form of payment used to make the initial transaction.

10. Nonpayment. Please be aware that if a balance remains unpaid after the 2nd statement you will incur a $10 late fee. After the 5th statement has been sent we will refer your account to a collection agency, in which case you will be charged an additional $40 collection fee. Partial payments will not be accepted unless otherwise negotiated with the Office Manager.

11. Methods of Payment. We accept most major credit cards including Visa, Mastercard, American Express, Discover, and CareCredit. We also accept cash and personal checks.

12. Returned Checks. If a check is returned to us you will be charged a $25 returned check fee.

13. Mail-In-Rebates. As a courtesy our office will supply you everything you need to submit your rebate in the form of rebate leaflets, invoices, and contact lens boxes. However, submission of mail-in rebates are solely between you and the manufacturer. We cannot submit on your behalf, inquire to the company about the status of your rebate, or reimburse you if you don’t receive your rebate.

14. Refunds. If you are unhappy with your lenses after a prescription check with the doctor our patients may receive one remake on their lenses at no cost. However we may not give a refund for any differences in price. If you wish to cancel your order you must do so the same day during office hours for a full refund. However if the order has begun processing you will be responsible for any lab or restocking fees incurred. To return contact lenses the boxes must be in good condition and cannot be accepted if they are opened, tampered with, or expired. The Manager on Duty will have the final say if the boxes are eligible at the time of the return request. Frame warranties are for one year from the dispense date and covers manufacturer damages or defects. It does not cover loss or theft.

Northglenn Optometric Center is committed to providing the best treatment to our patients. Our prices are representative of the usual and customary charges for our area.

Thank you for understanding our financial policy. Please let us know if you have any questions or concerns.