The topic of insurance has always been a confusing one when going to the eye doctor’s office. Most ophthalmology and optometry practices accept two types insurance, Medical Insurance (Blue Cross, HAP, United Healthcare, etc) and Vision Insurance (VSP, Eyemed, Davis, etc.) About 90% of Americans have medical insurance. Your health insurance may be provided by your employer, or you may purchase this insurance yourself. You may or not have vision insurance in addition to your medical insurance.
Vision insurance is actually an allowance designed to pay toward routine comprehensive eye examinations. A routine eye exam not only tests for visual impairment, but also for other underlying health issues. Even if you do not feel like you need glasses, many asymptomatic conditions exist that can be identified early on with an eye exam. A complete eye exam involves a series of tests designed to evaluate your vision and check for eye diseases. Optometrists and ophthalmologists use a wide variety of tests and procedures to examine your eyes. These tests range from simple ones, like having you read an eye chart, to complex tests, such as using a high-powered lens to visualize the tiny structures inside of your eyes. Each test during an eye exam evaluates a different aspect of your vision or eye health.. The refraction (determination of the glasses prescription) is included. Most vision insurance plans do not pay toward the contact lens evaluation portion of the examination, but may offer a discount on these services. Vision insurance plans often pay an allowance of (or offer a discount on) eyeglasses or contact lenses.
Medical insurance pays toward eye care visits that are medical in nature. An emergency visit, or one focused on a specific eye problem, would be submitted to medical insurance. A medical eye exam is typically covered by medical insurance and includes diagnosis and treatment of eye related medical diseases, such as macular degeneration, cataracts, corneal disease, eye infections, floaters, eyelids styes, dry eyes, glaucoma treatment, loss of vision caused by a medical condition of the eye, etc. A comprehensive medical eye exam can take an hour or two, depending on the doctor and the number and complexity of tests required to fully evaluate your vision and the health of your eyes.
Medical insurance may also pay toward a continuous comprehensive examinations if there is a medical reason for them such as diabetes, cataracts, glaucoma, etc. If there is a medical diagnosis, we are required to submit the examination to the medical, not vision, insurance. To add to the confusion, a comprehensive examination that is medical in nature and billed to medical insurance does not include the refraction (determination of glasses prescription.) Nearsightedness, farsightedness, astigmatism, and the need for reading glasses are not considered a medical diagnosis. Medical insurance plans will deny this portion of the examination. If you have both medical and vision insurance plans, our office will coordinate the benefits to minimize your out-of-pocket costs.