Patient Center

Online Forms

Welcome to our patient center!  Below you will find our online forms for new patients, please fill them out online prior to your upcoming appointment

Child New Patient Forms (Under Age 17) - Submit Online

Adult New Patient Form (Age 17 and Older) - Submit Online

Make a Payment Online
Patient Name:

Insurance and Payment Information

Patients without Insurance
We are not always able to determine our exam and office visit fees, since they depend on services rendered. We can give you an estimate ahead of time, but this may change depending on your visit requirements. Payment is due in full at the time of service. CareCredit is a great financing option for individuals without without insurance, ask our office staff or visit for more details.

The following are excepted payment methods at Eyecare Associates of Bluffton:

  • Cash
  • Check
  • Visa, MasterCard, American Express and Discover
  • Flexible Spending Plans
  • Health Savings Accounts (HSA)
  • CareCredit
Patients with Insurance
We will bill your insurance company for all services rendered. It is your responsibility to understand and know your insurance coverage. We will bill your insurance at the time of service. If payment isn't received from your insurance within 30 days of being billed, we will contact you for assistance. If your insurance denies coverage for any reason, you would be responsible for all charges. We would expect payment in full within 30 days after you receive a billing statement.

If you have any questions about your insurance benefits, please contact us (260-824-2020) for eligibility inquiries. Additionally, some insurances have multiple plans and we may or may not be a provider for their specific plan.

We will bill Medicare Part B plans for you. You must, however, supply us with the most up-to-date and correct information at the time of your visit. Please be aware that if you have turned your Medicare over to an HMO (also called a Medicare managed HMO) we can bill for services.

CareCredit is a convenient payment plan option. They offer low interest and sometimes zero interest payment plans. 95% of people who apply are approved. Approval is instant and can be used at Eyecare Associates of Bluffton. You can apply online through our CareCredit landing page. CLICK HERE

Patients with an HMO
Our office is not a provider for any HMO's. If you have an HMO, you will be treated as a private pay patient. We can bill for services from HMO, but you would still be responsible for payment at time of service. We will be more than happy to provide you with itemized receipts if you would like to try submitting them for reimbursement.

Patients with a PPO, EPO or POS
Co-payments are due at the time of your visit. If you haven't met your deductible, your insurance will inform us when we bill them and you will be responsible for the full amount applied to your deductible. Please note that if we are not a preferred provider of your insurance, reimbursements will be at their "out-of-network" rate.

Medical Insurance PPO plans we accept:

  • Medicare
  • Blue Cross
  • Blue Cross Blue Shield
  • Blue Shield
  • Cigna Health Care
  • United Health Care
  • Aetna
  • Tricare
  • Medicaid
  • Hoosier Healthwise
  • Indiana Health Network(IHN)
  • Healthy Indiana Plan (HIP)
  • AARP Medicare Complete
  • Golden Rule
  • UMR
Vision Insurance plans we accept:

  • VSP
  • EyeMed
  • Aetna Select
  • Blue View Vision
  • Cigna
  • Humana Vision
  • Comp Benefits (VCP)
  • Davis Vision - GE employees only
  • Medicaid
  • Hoosier Healthwise (Anthem/MD Wise/Managed Health Services)
  • Healthy Indiana Plan (Anthem/MD Wise/Managed Health Services)
Please verify your insurance with us first to ensure that we are a provider of your plan.
If you have any questions or concerns, please let us know. We would be more than happy to assist you.

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