Today's healthcare environment has become more complicated and challenging to understand. We hope to give you a better understanding of eye related insurance benefits with the information below.
An optometrist is a medical doctor (just like your family doctor) and provides comprehensive, medical eye health exams. However, optometrists also provide healthy, routine vision exams for people without any eye disorders.
Medical insurance can cover eye care related to a medical condition. For example, if you need an eye exam because of eye strain, lazy eye, dry eyes, vision loss, floaters, cataracts, allergies, infections, complications from diabetes or high blood pressure, then your medical insurance will be billed for these services. Vision discount plans do not cover any part of an eye health exam considered “medical”.
Some medical insurance plans will also provide routine eye care coverage for healthy eye and vision exams.
Vision discount plans provide a wellness benefit and generally only cover routine care such as a healthy eye and vision exam and include glasses or contact lenses. In some cases there may be a co-pay for each patient. The co-pay must be paid at the time of service. Each specific vision discount plan contributes to eyewear or contact lens purchases at different levels. Eyeglass frames, lenses and contact lenses can usually be purchased at a discount, but not every plan has this benefit.
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 separate fee for the refraction. This charge must be paid for at the time of service. Unless immediately following cataract surgery, there is no eyewear benefit under the Medicare program. The purchase of frames, lenses and lens options is the responsibility of each Medicare patient.
Sometimes insurance benefits can be coordinated so portions can go to your medical insurance and portions can go to your vision discount plan. Our billing specialists will submit all pertinent information to your insurance companies to help you maximize your insurance benefits as you receive individualized eye care. If some fees are not paid by your plan, we will bill you for any unpaid deductibles, co-pays or non-covered services. If our doctors do not participate in your insurance plan, we will be happy to provide you all the necessary forms and documentation for you to submit to your carrier for reimbursement.