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Today's health care environment has become more confusing and complex. Understanding your health insurance and vision benefit is not as easy as it once was. Our practice has provided this information to untangle and clarify many misconceptions about third party care and your vision.
What is the difference between Vision insurance and Medical/Health insurance?
One of the most challenging billing issues in an optometric office is whether we should be billing the vision or medical plan.
An optometrist is a medical doctor (just like your family doctor or cardiologist) and provides very comprehensive, medical eye health exams. However, optometrists also provide routine vision exams for people without any eye disorders.
A vision insurance policy is different from your health insurance policy. Regular health insurance protects you from unexpected costs for eye injury or disease. In contrast, vision insurance provides an added wellness benefit for healthy eye exams, which includes routine eye care, prescription eyewear and contact lenses. Some examples of vision insurance include Davis Vision, Vision Service Plan, Spectera and Eyemed.
What does vision insurance cover? Generally, they cover routine care, such as an annual exam and glasses or contact lenses.
Check with your plan to see if your benefits cover you once every year or once every two years. Eyeglass frames and lenses and contact lenses can usually be purchased at a discount, but not every plan has this benefit.
What does vision insurance NOT cover?
Vision plans do not cover any part of an eye health exam considered “medical”. Medical insurance generally covers only eye care in relation to a medical condition. For instance, if you need an eye exam because of vision loss, floaters, allergies, infections, cataracts, dry eyes, complications from diabetes, or in relation to diagnosed high blood pressure, then your health insurance will be billed for these services. You don’t need vision insurance for this coverage, but you may be able to use your health insurance to cover your medical eye condition or eye care needs and then use your vision insurance to cover your glasses or contact lenses. Please be aware that many medical plans are no longer paying for eye exams because of a diagnosis of blurred vision or a headache. They are considering this a routine vision exam and are often not paying for the exam.
We will bill your insurance if we are participating providers and your insurance information is presented at time of service. If some fees are not paid by your plan, we will bill you for any unpaid deductibles, co-pays or non-covered services,
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Vision Service Plan
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The Vision Service Plan (VSP) - In most cases, VSP will fully cover your eye health and vision exam. In some cases there may be a co-pay on the part of each patient. The co-pay must be paid at the time of service. The eyewear component of the Vision Service Plan contributes or subsidizes the purchase of your eyewear. Each specific Vision Service Plan subsidizes eyewear purchases at different levels. The Vision Service Plan is not an entitlement plan and patients are free to choose any frame or lens option recommended by their doctor. Our professional optical staff will be happy to determine if any out-of-pocket costs will be incurred by the patient.
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MEDICARE
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Our practice fully participates in the Medicare program. We accept assignment of benefits on behalf of each eligible patient. The eye health examination is a fully covered service under the Medicare program. However, as mandated by Federal law, the refraction part of the vision section of your exam is a non-covered service. Each Medicare patient will be charged a seperate fee for the refraction. This charge must be paid for at the time of service during your visit. Unless, immediately following cataract surgery, there is no longer an eyewear benefit under the Medicare program. The purchase of frames, lenses, lens options and coatings is the responsibility of each Medicare patient.
Hopefully, this information will give you a better idea of the vision benefit you are using today. Our insurance coordinator is available to answer any questions. Due to the large number of different Vision Insurance Benefit Programs, it is impossible to know the specific details and reimbursement policies of each. If our doctors do not participate in your Vision Benefit Program, we will be happy to provide you all the necessary forms and documentation for you to submit to the carrier for reimbursement.
Thank you for your understanding and patience.
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