Patient Resources

What does my Vision Plan cover?

Most vision plans cover one “well” eye exam every 1-2 years and partial or discounted hardware coverage, including glasses and/or contact lenses. Your exam includes a refractive diagnosis, which determines your eyeglass prescription and an in-depth evaluation of the health of your eyes. Vision plans cover vision diagnosis’ known as nearsighted, farsighted and some forms of astigmatism.

What does my Vision Plan NOT cover?

Vision plans do not cover medical eye care. Office calls for infections, injury, dry eyes, allergy, floaters, vision loss, disease management, etc. are not covered under your vision plan. These appointments are billed to your medical insurance plan. In addition, any specialty testing that may be performed during your routine eye exam or medical office call is required to be billed medically and is not covered by your vision plan.

Why are you billing my Medical Insurance?

If you are having a problem with your eyes or vision that we find to be caused by a medical issue or if you have a pre-existing condition or any disease that can affect vision or cause blindness (cataracts, glaucoma, dry eye, diabetes, high blood pressure, cholesterol, etc.) then your appointment will be considered medical care. In addition, any specialty testing used to diagnose or monitor an eye issue is considered medical care, even if the test is performed during your routine eye exam. These services will be billed to your major medical insurance and may be subject to deductible and/or co-insurance. Vision plans do not cover medical eye care.

How do you decide which insurance entity to bill?

We must follow the rules that are set by our contract with your insurance company. At the time of service, we require documentation of both your Vision Plan and Medical Insurance. Once you have been evaluated by the doctor, the billed entity is determined by the final diagnosis and treatment plan.

Why is there a contact lens evaluation fee?

This fee covers the extra tests performed by the doctors along with any necessary follow-up visits and trial lenses. These procedures are only done on patients that wear contacts; in addition to the services provided during the annual eye exam.

Why doesn’t my insurance cover that fee?

Insurance companies view most contact lenses as elective vision correction. Most insurance companies take the position that if your vision can be corrected with glasses, then contacts are not medically necessary and therefore, are not covered as extensively as glasses and your annual eye exam.

What if I still have questions?

We believe that understanding your insurance and our policies is an essential part of quality care. If you have any questions regarding your vision coverage or these policies, please feel free to contact our office. You may also find it helpful to contact your insurance company, vision plan and/or human resource department.