COMPREHENSIVE EYE EXAMINATIONS
A comprehensive eye examination has a cost of $180 and typically takes approximately 45-60 minutes. Exams include a full vision and eye health assessment by your optometrist as well as retinal/fundus photos. Your exam may require eye dilation which can affect your vision for 2-5 hours; please make any necessary arrangements for transportation as driving may be difficult during this time. Eye examinations include a prescription for glasses, if required – note that we do not provide any measurements or consultation regarding the purchase of glasses online.
We offer direct billing to all major insurance companies. Please note we only bill primary insurance plans (no secondary or coordination of benefits), and do not submit predetermination requests.
OHIP COVERAGE: Your examination may be covered by OHIP if you are 19 or younger, 65 or older, or have certain systemic or ocular conditions such as diabetes. Please check with our staff for eligibility. Eye examinations covered under OHIP do not include any specialized imaging or additional specialty services.
Eye examinations do not include consultation regarding contact lenses, laser eye surgery, myopia control, vision therapy, or other specialized services or imaging. If you are interested in any of these, please let us know.
CONTACT LENSES: In order to prescribe contact lenses, your optometrist will have to conduct a Contact Lens Fitting to test different lenses and how they fit and feel on your eyes. A Contact Lens Fitting costs $50 to $100 depending on the types of lenses and your experience wearing them. For more information, please consult your optometrist.
BENEFITS INSURANCE DIRECT BILLING AUTHORIZATION AND CONSENT
CONSENT TO COLLECT AND EXCHANGE PERSONAL INFORMATION
Personal information that we collect and disclose about you is used by the insurer, plan administrator of your group benefits plan, its affiliates, or their service provider(s) for the purposes of assessing eligibility for your claims, underwriting, investigating, auditing and otherwise administering the group benefits plan, including the investigation of fraud and/or plan abuse and for internal data management and data analytical purposes.
If I have provided my benefits insurance information, I authorize Tonic Eye Care & Vision Therapy to collect, use, and disclose personal information with the insurer or plan administrator for the above purposes. I authorize such insurer or plan administrator to use or exchange my personal information with any other relevant party for the above purposes. I understand that personal information may be subject to disclosure to those authorized under applicable law.
In the event there is suspicion of fraud or plan abuse concerning any claims submitted, I acknowledge and agree that the insurer or plan administrator and their service providers may disclose relevant personal information to any relevant organization, my employer, or benefit plan sponsor, for the investigation and prevention of fraud and/or benefit plan abuse. I understand that the submission of fraudulent claims is a criminal offence.
I authorize the recovery of the full amount of any overpayment from any amount payable under the group benefits plan, and the exchange of personal information with other persons or organizations, for that purpose.
BENEFIT ASSIGNMENT
I hereby assign benefits payable for the eligible claims to Tonic Eye Care & Vision Therapy for submitting my claims electronically to the group benefits plan and I authorize the insurer/plan administrator to issue payment directly to such provider. In the event my claim(s) are declined by the insurer/plan administrator, I understand that I remain responsible for payment to the healthcare provider for any services rendered and/or supplies provided.
I acknowledge and agree that the insurer/plan administrator is under no obligation to accept this benefit assignment form, and that any benefit payment made in accordance with this benefit assignment form will discharge the insurer/plan administrator of its obligations with respect to that benefit payment. I understand that this assignment will apply to all eligible claims submitted electronically by Tonic Eye Care & Vision Therapy and that I may revoke it at any time by providing written notice to the insurer/plan administrator.
If not myself, I confirm that the patient has given their consent to provide their personal information to use and disclose their personal information as set out above. I confirm that I am authorized by the plan member to execute an assignment of benefit payments to Tonic Eye Care & Vision Therapy. 80