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/orcontact lens services and materials.

4. What does my vision plan notcover?
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.


Vision plans that we are in-network for:

VSP (Vision Service Plan) – Please have the name, date of birth, and last four digits of the social security number for the primary subscriber or the full ID number for the primary subscriber in the event there is a card with an ID number.

EBMS(Heart of the Rockies Regional MedicalEmployees) -Please have the Medical card, name and date of birth of the primary subscriber.

CEBT/CNIC (Chaffee County Employees) – Please have the Medical card, name and date of birth of the primary subscriber.

Medicaid – For children and adults under 21, there is a benefit for an annual exam and a basic pair of glasses. For 21 and over, there is a benefit for an annual exam. Medical care is on an as needed basis. Copays may apply.

Colorado Choice – This plan generally has a VSP benefit built into it.
Please have the Medical card, name and date of birth of the primary subscriber as well as the medical card for the patient (if different than the primary).

Colorado Choice Chp+ – This plan has a VSP vision benefit built into it. Please have the medical card for the patient.

Colorado Access Chp+ – Please have the medical card for the patient.

Rocky Mountain Health Chp+ – Please have the medical card for the patient.


Vision plans that we are out-of-network for:

However, you may have an out of network reimbursement if you choose to still use our services. You can call your carrier to find out how much you would be eligible for in reimbursement. I have linked the out of network forms below each carrier.

Eyemed
https://portal.eyemedvisioncare.com/pdf/member/OONClaimForm.pdf

Davis – log in to access the form
http://www.davisvision.com/Member-FAQs/

UHC Vision/Spectera
https://www.uhc.com/content/dam/uhcdotcom/en/SBS/PDF/claim-form-vision.pdf

Superior
https://www.superiorvision.com/PDF/member/MemReimbClaimForm.pdf