I understand Leet EyeCare will bill my vision and/or health insurance. I know that I am responsible for any remaining balance after the claim is submitted. Should my insurance not cover the services that are submitted in full, I agree to pay any outstanding balance.
In cases of divorce, the individual who receives the care is responsible for all charges. We will not bill a divorced spouse for the patient’s services. For minor patients, the responsible party bringing the minor patient to the clinic will be responsible for any co-pays or co-insurance at time of service.