If your insurance company is not on our list, we will be happy to provide you with a detailed summary of services that we provide for you that you can submit to your insurance company, and you will be directly reimbursed by them. We will need payment in full from you on the day that services and/or materials are provided in this case.
We often have patients that have both vision insurance (VSP or EyeMed) and medical insurance (Anthem Blue Cross, Aetna, Cigna, or Medicare). They are very different in terms of the services they cover, and it’s important for our patients to understand these differences.
Vision insurance is designed mainly to cover determining a prescription for glasses, to help pay for glasses or contact lenses, and to cover a yearly routine Wellness Evaluation of the health of the eyes in a healthy patient that has no particular problems or symptoms. It is not equipped to deal with and does not cover medical conditions, injuries, and/or treatments.
Medical insurance is designed to cover you when you have a medical problem, including one that affects your eyes. Medical insurance does not typically cover routine vision examination or services for glasses, or routine vision problems such as nearsightedness, farsightedness, and astigmatism. Those are only covered by your vision insurance.
When a medical diagnosis or medical condition is present that affects your eyes, such as high blood pressure, high cholesterol, or diabetes, to name just a few examples, or you have an eye disease or eye problems such as an infection (pink eye), dry eyes, allergies, glaucoma, or cataracts, we must file the claim with your medical insurance, and the co-pays and deductibles for that insurance will apply.
Your vision plan does not cover these kinds of problems. Our office does not make these rules; they are made by the insurance companies themselves, and we must comply with them. There is often no way to know prior to your examination which type of insurance will be the right one to file your claim with.
We make every effort to join as many insurance panels, both medical and vision, as we can for your convenience. If we are on your insurance company’s panel, we will file those claims for you. In the event that we do not accept your medical or vision insurance, we will provide you with an itemized receipt so that you may file a claim for reimbursement with your insurance company yourself. If you have any questions, we’re more than happy to help.