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Forms and Financial

Patient Forms

** Please print, complete, and return by mail to our Mount Vernon address: 2100 Little Mountain Lane, Mount Vernon, WA 98274.

Using Insurance

We’re happy to bill your primary insurance company for you. We can get an estimate of your benefits so you’ll have a better idea of what your insurance may cover. We can also provide you the necessary information so that you can bill any secondary coverage you may have.

When we quote you benefits, this is only an estimate of your coverage and not a guarantee of payment. We relay the information given to us by your insurance company. This information is not always accurate. Consult the benefits information that you received from your employer for more detailed information. When your insurance company processes the claim, they may pay differently than what they initially stated. You are ultimately responsible for any charges.

Here are just a few of the plans we can bill for you:


Regence Check your benefits on-line
Premera Check your benefits on-line
Vision Service Plan (VSP) Check your benefits on-line (Please note that there are some VSP plans that are NOT contracted with us. You may need to call your VSP provider to learn if we are contracted.)
Northwest Benefit Network (NBN) Check your benefits on-line
Davis Vision Check your benefits on-line
First Choice Network Call the number on the back of your card for benefit information
Uniform Medical Plan Check your benefits on-line
LifeWise Health Plan Check your benefits on-line
GroupHealth Cooperative Check your benefits on-line
Medicare Covers 80% of the medical portion of the exam after deductible.

Acceptable Forms of Payment and Payment Options

Here at Cascadia Eye and Eye Associates Surgery Center, financial consideration should not be an obstacle in obtaining the eye care you deserve. Our goal is to make eye care, including refractive surgery and other higher priced eye care needs, affordable for any budget. You may choose any of the following payment options:

Cash or Check — If we will not be billing insurance or you are paying for a “non-covered” service or product we offer a generous pay-at-the-time-of-service discount for your exams and refractive surgery. Your balance must be paid at the time of service to qualify for this discount.

Credit Card — We accept Visa, MasterCard and American Express. AND you can now pay your bills online!

Financing – We work with Care Credit® to offer up to 12 months interest fee for refractive and cosmetic procedures only. If you choose to extend your payment period beyond the initial 12 months, significant interest fees will apply.

Apply Online – Click Here

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