Insurance

Vision Insurance vs. Medical Insurance

1. How do I know if I have a vision plan and what it is?
If your plan was purchased or provided through your employer, your HR department is always a good source of information. Sometimes, your medical plan can tell you who your vision carrier is (it isn’t always the same as your medical carrier). Do not assume that just because we are listed as “in-network” for your medical plan that we are in-network for your vision plan. Many times, they use completely different networks even though they may sound similar.

2. Won’t it be on my card?
Not always. Quite a few vision plans do not send cards and few put the information on your medical card.

3. What does my vision plan (Ex. VSP, EBMS, CEBT) cover?
Your vision plan is intended for comprehensive “routine” eye exams. This includes a refraction to determine your eyeglass prescription and a thorough screening for eye diseases/disorders. Most vision plans include coverage or discounts for eyeglasses, and/or contact lens services and materials.

4. What does my vision plan not cover?
Vision plans do not cover medical eye exams.

5. What is a medical eye exam?
If you are having a problem with your eyes or vision that is found to be caused by a medical eye problem, then your exam is a medical eye exam. For example, if you are having difficulty seeing with your glasses, and the doctor finds that your blurry vision is caused by cataracts, then your exam is a medical eye exam. If you have a pre-existing condition (cataracts, glaucoma, dry eye, macular degeneration, etc.), then your exam will be a medical eye exam. Injuries and infections are also medical in nature and therefore not covered by your vision plan.

6. Does my insurance cover medical eye exams?
Vision plans generally do not cover medical eye exams. However, these services will be covered by your major medical insurance. We are providers for Medicare, Medicaid, Blue Cross Blue Shield and many other health plans. In some cases, the care can be coordinated between the two, but the medical plan will always be the primary payer. All medical care is subject to your copays and deductibles.

7. Why is this so complicated?
Unfortunately, we are required to follow the rules set by the insurance companies which are not always straightforward.

8. What else do I need to know?
Even if your eye exam is billed to your medical insurance, you may still use a vision benefit to purchase eyeglasses or contact lenses.

9. I still have questions.
We would be happy to answer any questions that you may have about your insurance coverage. You may also want to consult with your insurance company, or human resources department.