Your Eyes and Your Insurance Plan (or Plans): Seeing Double to Protect Your Vision

By: Dr. Troy Raber, O.D.
Navigating through the world of insurance can be time consuming and at times quite frustrating. With a foreign sounding language of referrals, co-pays, deductibles and abbreviations such as PPO, HMO, EOB, HSA, VSP and VBA, Halpern Eye Associates is always willing to help translate and sort out the details.

One area of common confusion is a result of having multiple insurance plans that cover your eyes and vision. The two insurance plans are your medical insurance and your vision insurance.

Medical Insurance

Many patients are familiar with their Medical Insurance coverage. This is the insurance that you use for visits to your primary care doctor, specialists, lab testing or visits to the emergency room. If your visit to HEA is medically related then this is the insurance plan that will be billed. Typical types of visits that are covered by your medical insurance are those related to medical eye complaints such as injury, pain, redness, itching, tearing, flashes, floaters and double vision. In addition you may be followed for specific conditions such as cataracts, glaucoma, diabetic eye disease or macular degeneration that would fall under your medical insurance. Most medical insurance plans, including Medicare, do not cover the cost of the refraction, which is the procedure done to determines an eyeglass prescription.

Vision Plan

In addition to your medical insurance coverage, your employer may offer you a Vision Plan. This plan may be part of your medical insurance and covered by the same insurance carrier or may be provided by another carrier with a different name. Vision plans cover what is considered by many as a routine annual eye exam. The purpose of this exam is to complete a refraction to determine the need for prescription eye wear and provide and overall comprehensive evaluation of the health of your eyes. If any abnormalities or signs of eye disease are detected, your treatment may include returning for additional testing or follow up care that would be covered by your medical insurance.

In addition to coverage for your annual eye examination, most vision plans will offer either a discount or dollar amount towards the purchase of eye glasses or contact lenses.

Seeing Double- Which Plan to Use?

The reason for your appointment will determine which insurance plan will be billed at that visit. If you are making an appointment for an annual exam without any vision problems, need updated glasses or contacts or have a vision problem such as blurred vision for reading or driving this would be covered under your vision insurance.

For most other visits related to eye injuries, diseases or new problems discussed above, your medical insurance should apply. Be sure to have information for both your medical insurance and your vision plans when making an appointment or contact our patient coordinators for additional assistance.

Medical Insurance Plans Vision Plans
Medicare Davis
Aetna* Eyemed
BCBS* NVA
Coventry* Spectera
Medicaid* Superior
MAMSI* VBA
Optimum Choice* VSP
Tricare*
*May offer coverage for routine vision exam
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