Understanding the Difference Between Vision Plans and Medical Insurances

Today's health care environment has become more confusing and complex. Understanding your vision and medical benefits is not as easy as it once was. Our practice is providing this information to clarify many misconceptions about third party insurance and your vision. In order to understand the complexities of your coverage, it helps to understand that there are two distinct sides of vision care. The first is medical eye care which covers all testing, diagnosis, and treatment of eye disease. The second is routine vision for those with healthy eyes. Third party payers usually reflect that difference. As a general rule, medical insurance pays for medical eye care and Vision Plans deal with routine vision, the exception being that some medical plans will pay for routine eye care. What many consumers don't realize is that by virtue of the medical nature of eye care, MOST eye exams are covered under their regular medical insurance, and that you don't need separate "vision insurance" to be covered.

Many common vision plans ONLY cover the routine vision part of the overall eye health examination, i.e, VSP, Eyemed, Davis Vision, Spectera,etc. These plans are not really insurance in the traditional sense that they spread risk, but are much more marketing plans that drive patients to participating practices. By definition, it is impossible to "insure" routine things. The reality is, vision plans are a middle man, dressed up to look like insurance, that extract a profit from the routine business of eyecare. Since we also must profit from the routine business of eyecare to exist, the cost is passed on to consumers in ways that aren't immediately noticeable. Typically, the consumer pays the price of reduced quality, since providers who accept vision plans have to make up the dramatic discounts vision plans demand by increasing volume and playing games with their retail markups in their optical to remain profitable. Because we strongly believe we can offer higher quality care and better quality retail optical without the encumbrances of Vision Plans, we do not contract with third party"vision only" insurances. As non-participating providers, we will be happy to complete all the necessary forms, provide documentation and submit them on your behalf to the vision plan carrier for your reimbursement.


Understanding that are two distinct and important elements of every visit to our practice may help you understand the role of your medical insurance. Because many eye diseases that affect your vision will have little or no symptoms until the problem has become sight-threatening, all eye exams have a medical component. In fact, the most important goal of your visit today is to insure quality of life by providing you with a comprehensive, thorough medical examination of your visual system. Regular eye health examinations are critical to prevent debilitating eye disease, and can include the use of cutting edge technologies designed to take the guesswork out of disease detection. The second component of all comprehensive medical eye exams include a routine vision component to analyze and prescribe, if necessary, eyewear or contact lenses to correct your vision. Our insurance billing specialists will contact your insurance company before your visit is completed to verify your eligibility and coverage to maximize your insurance benefits.

Our doctors participate in the Medicare program and accept assignment on behalf of each eligible patient. The eye health examination is a fully covered service under the Medicare program when there is a medical condition, dry eye, cataracts, allergies, glaucoma, etc. However, as mandated by Federal law, the refraction part of the vision section of your exam is a non-covered benefit. There are many new Medicare Advantage plans with private insurance companies that we participate in.

Flex-spending, or Cafeteria plans are an option that your employer may offer which allow you to set aside pre-tax dollars to pay for your medical expenses such as eye exams, glasses or contact lenses. Please contact your employer to take advantage of this option.

Our billing staff are always available to contact your insurance company before your appointment is made to check your benefits for you. We are here to help you will all your insurance needs until your claim is completely processed.

--Barri