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HIPPA Policy

Financial Assignment and Agreement

Please remember that insurance is considered a method of reimbursing the patient for fees paid to the doctor and is not a substitute for payment. Some companies pay fixed allowances for certain procedures. and others pay a percentage of the charge. What we as medical professionals see as medically necessary, May not be what your insurance plans agrees with medically necessary and therefore will treat as a "non-covered investigational service". Ultimately it is our duty to inform you of the services available to provide you with the best care so that you can make an informed decision about your health. it is your responsibility to pay any amount, co-insurance. or any other balance not paid for by your insurance. In the event of payment by insurance and patient over payment please allow 90 days from receipt of insurance payment to process patient refund requests. Please note that bounced checks will be assessed a $25.00 fee.


In order to control cost of billings, we request that your charges for office visits be paid at the conclusion of each visit, this includes co-insurance and deductable applicable to each visit. 

I request that payment of authorized Medicare and/or insurance benefits be made on my behalf for any services furnished me. I authorize any holder of medical information about me to release to the Health Care Financing Administration, its agents, or any insurance carrier I may have. any information needed to determine these benefits or the benefits payable for related services.


This assignment will remain in effect until revoked by me in writing. A photocopy of this assignment is to be considered as valid as an original. I understand that I am financially responsible for all charges whether or not paid by said insurance. I hereby authorize said assignee to release all information necessary to secure payment.


Authorize to Release Confidential Information

I authorize Ruben E. Ramirez. MD. and/or Monica v. Ramirez. 0.0. and/or the staff of Buena Vista Eye Care to disclose information and records regarding my medical condition and medical and surgical treatment(s) to my other health-care providers and to my insurance carriers.

Information Regarding Dilating Eye Drops

Dilating drops are used to dilate or enlarge the pupils of the eye to allow eye doctor to get a better view of the inside of your eye. Not all insurance panels view this as a covered service for your exam. if so, then there will be a $15.00 charge. Dilating drops frequently blur vision for a length of time which varies from person to person and may make bright lights bothersome. It is not possible for your eye doctor to predict how much your vision will be affected. Because driving may be difficult immediately after examination, you are advised not to drive yourself for 24 hours after your examination today. Adverse reaction. such as acute angle-closure glaucoma. may be triggered from the dilating drops. This is extremely rare and usually treatable with immediate medical attention.

Notice Regarding Refraction Fees

I understand that payment for the refraction (eyeglass prescription) portion of a complete eye examination is usually not covered by medical insurance and is my responsibility. The usual charge for this service is $50.00.

Important Medical insurance Information

  1. Some procedures require an additional payment separate from your co-pay. (This is considered under your insurance to be a co-insurance or deductible).
  2. Some procedures might not be covered by your insurance and might leave a responsible balance on your account once we receive an 508 (explanation of benefits) from your insurance.
  3. Medicare Patients: It is your responsibility to notify the office if you have changed your plan to an HMO/Manage care.
  4. Routine physical exams are not always covered by your insurance. (Please check with your insurance company. you may be expected to pay in full the day of your exam).
  5. Our preferred Facilities are: El Paso Day Surgery, Surgical Center of El Paso, UMC, and Sierra.

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Location & Hours

Office Hours

Walk in patients are always welcome!!

El Paso Office


7:45 am-5:00 pm


7:45 am-5:00 pm


7:45 am-5:00 pm


7:45 am-5:00 pm


7:45 am-1:00 pm