We agree with many of our patients that the concept of distinguishing between vision insurance benefits and medical insurance benefits can be very confusing. Insurance coverage and benefits are often designed to require an inordinate amount of time to decipher. Our goal at Columbia Eye Consultants Optometry is to make our billing practices as fair and transparent as possible.
Eye care can be especially confusing for patients because some patients have both vision and medical insurance plans. Vision insurance plans cover “routine” eye exams and a portion of glasses and/or contact lenses. A routine vision exam assumes that there are no symptoms related to a medical eye diagnosis, no existing medical eye diagnoses are present, no advanced eye health testing is warranted, and no medical eye problems are discovered. When a patient presents under any of the circumstances above, the exam must be submitted to the patient’s medical plan for coverage.
Most medical insurance plans are unlikely to cover a routine exam with no medical eye problems (there are a few exceptions to this). Likewise, a vision plan is not appropriate to cover an exam for a patient with problems or symptoms related to a medical eye diagnosis. If an exam, or any indicated medical testing associated with that exam, is submitted to the medical insurance plan, vision insurance may still be used towards glasses and/or contact lenses. In some cases, your vision insurance may even pick up a portion of your exam visit that your medical insurance did not cover. This is called “Coordination of Benefits”.
Our team at Columbia Eye Consultants Optometry will work with you to determine which coverage is appropriate for your visit and will be happy to answer any of your questions regarding your vision and/or medical coverage.
Some of the most common insurance vision providers include VSP, Eyemed, and NVA. We accept all three of these options and are more than happy to discuss your benefits at any time. Our billing department has extensive experience dealing with these providers and their plans. Some employers offer vision plans as an adjunct to your major medical insurance plan. Vision insurance will pay toward routine eye exams that find no medical diagnoses. They will also offer you an allowance to use towards your purchase glasses or contacts. The amount will vary from insurance to insurance.
Medical insurance will cover a portion of your visit if a medical diagnosis is present. This coverage may be subject to your deductible. A deductible is a set amount that your insurance plan requires you to spend before its coverage kicks in. Examples of medical diagnosis include, but are not limited to, headaches, diabetes, cataracts, glaucoma, dry eye, floaters, allergies, etc. Your doctor will discuss these diagnoses with you and describe how they influence your vision and your eye health. If a medical diagnosis is present, then we are required to submit to medical insurance, even if you have vision insurance.
If you have both medical and vision insurance plans, our office will attempt to coordinate your benefits to minimize your out-of-pocket costs, when possible. We understand that insurance can be a tricky subject and you may not have the time to dissect all the details involved. Besides providing quality eye care, we are a resource for you to utilize to better understand the benefits that are provided to you through your insurance plan. We are happy to answer any of your questions regarding insurance coverage at any time.
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