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To save time during your appointment, print out these forms, fill them out and bring them with you.
Registration Form |
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Patient History
Questionnaire |
Notice of Privacy Act |
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 Please note that these are PDFs. If you do not have Adobe Acrobat Reader on your computer, click here or on the logo at right to download the program and open these files.
We want you to get all of the benefits you are eligible for from your health insurance coverage. Many health insurance plans require a referral from your primary care physician prior to consultation with a specialist. In addition, most plans also require preauthorization before any type of surgical procedure or laser treatment. It is your responsibility to obtain the required referral from your primary care physician. Failure to obtain a referral or preauthorization, if required, will result in your health insurance denying payment for our services. In this case, you will be held financially responsible for all services obtained through our office.
If you are uncertain whether your health insurance requires a referral or preauthorization, please call your health insurance’s customer service representative or your primary care physician’s office for more details. If you need assistance, please call our Billing Department at (718) 261-4120 Monday through Friday 9:00 am to 5:00 pm.
Fidelis Medicare Advantage United Health Complete
- 1199 National Benefit Fund
- Aetna/US Healthcare (HMO, PPO, POS)
- Affinity
- Atlantis
- Beech Street
- Blue Cross/Blue Shield (HMO, POS, PPO)
- Centercare
- Cigna (PPO, Open Access Plus)
- Connecticare
- Emblem Health CompreHealth
- Emblem Health EPO
- Empire Plan
- Elder Plan
- Evercare
- Fidelis
- Fidelis Medicare Advantage
- First Health
- GHI
- Great West
- Healthnet (PHS)
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- Health First
- Horizon (Mulitplan Only)
- HIP
- HIP-CMO
- Magnacare
- Medicare Advantage Plan (VNS Choice Select)
- Medicare-Empire
- Medicare-GHI
- MedNet/Galaxy Health Plan
- Metroplus
- Multiplan
- Oxford (All Plans)
- PerfectHealth
- PHCS
- Railroad Medicare
- Select Pro
- Storeworkers Security Plan
- Unicare
- United Health Complete
- US Family Health Plan
- VNS Choice
- Most Local Carriers
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Please Note: We do not accept GHI HMO |
Please call our Billing Department for more information if you do not see your insurance plan listed.
Many health insurances require a co-payment. You are required to pay for any co-payments at the time of your visit. We will bill your health insurance directly for our services. After your health insurance has made payment, we will send you a bill for any applicable patient balances (i.e. deductibles).
At Fromer Eye Centers we understand everyone has different needs in fulfilling their financial obligations. Most health plans consider laser vision correction elective and therefore do not cover it, but check with your plan to be sure, we provide various payment plans suited to each patient.
Option A - No Initial Payment
- Financing is available through Vision Fee Plan at 1-877-559-5050
- Rates as low as 5.9% APR
- Low monthly payments for up to 60 months
- No prepayment penalties
- Hassle-free application and online decision in minutes
- Interest-free options available
Option B - Flexible Spending Plans
Many employers offer this as a health benefit. FSP, these plans are pre-tax contributions made directly from your paycheck and can be used for eligible healthcare-related expenses such as Laser Vision Correction. For more information on this type of plan check with your health insurance administrator.
Option C - Payment in Full
We accept cash, check, and all major credit cards.
For any questions/comments please click here to contact us.
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