This page describes two financial policies. The first explains the Financial Assignment and Non-Covered Benefits policies of Robert M. Scharf, M.D.

The second offers an interest-free purchase plan when ordering contacts or glasses for which the charges are $300 or greater.

By clicking here, you may return to the Resources Page.

 

FINANCIAL ASSIGNMENT

A more complete version of the following form will be provided to you at our office for your signature prior to rendering any medical or office services for you.

1. I hereby authorize payment directly to ROBERT M. SCHARF, M.D. all insurance benefits otherwise payable to me for services rendered. I understand that I am financially responsible for all charges incurred, including refraction, specialized testing and all other services rendered on my behalf or for my dependents, whether or not these services are paid for by insurance.

2. I understand that I am financially responsible for "NON-COVERED BENEFITS." A "NON-COVERED BENEFIT" is the patient's responsibility even if the insurance Explanation of Benefits (EOB) says that the patient is not financially responsible. This is because those services are not part of the insurance contract with the doctor and you may request not to have those services provided to you.

3. I authorize ROBERT M. SCHARF, M.D. and/or any other provider or supplier in the office of ROBERT M. SCHARF, M.D. to release any information required to secure the payment of benefits or to provide for necessary medical services for me or my dependents.

4. I authorize the use of my signature on all insurance submissions.


INTEREST-FREE FINANCING

We are happy to introduce Interest-Free Financing for our patients. It will beavailable to any  patient who charges $300 or more for any of our services. That includes specialty contacts and glasses.

The financing period will be for six months.

The minimum payment will be $100.

The payments will be divided equally so that the entire charge will be paid off in six months.

Please call our office at (972) 596-3328 for any questions you may have.