We often have patients that have both vision insurance (for example, VSP or EyeMed) and medical insurance (for example, Blue Cross, Aetna, Blue Shield, or Medicare).  These two types of insurance vary significantly in terms of the services they cover, and it's important for our patients to understand these differences.

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Vision insurance is designed to cover determining a prescription for glasses, to help pay for glasses or contact lenses, and to cover a yearly routine evaluation of the health of the eyes in a healthy patient that has no problems or symptoms.  Vision insurance does not cover medical eye conditions, treatments, and surgeries.  You may pay out of pocket for a vision, refraction, and contact lens exam if you don’t have vision insurance.

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Medical insurance is designed to cover when you have a medical problem, including one that affects your eyes. Medical insurance does not cover routine services or examinations for glasses, or routine vision problems such as nearsightedness, farsightedness, and astigmatism.  Those are only covered by your vision insurance.

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If a medical diagnosis or condition impacting the eyes is present, we are required to submit the claim to your medical insurance, and any applicable co-pays and deductibles for that insurance will apply. Medical eye conditions such as glaucoma, cataracts, retinal disorders, and dry eye are examples of cases where vision insurance does not cover the costs of exams, tests, treatments, or surgeries. It is important to note that our office does not establish these rules; they are determined by the insurance companies themselves, and we must adhere to their policies.

 

We make every effort to join as many insurance panels, both medical and vision, as we can for your convenience. If we are on your insurance company's panel, we will file those claims for you. If we do not accept your medical or vision insurance, we will provide you with an itemized receipt so that you may file a claim for reimbursement with your insurance company yourself.   Please let us know if you have any questions.