As an Optometrist, dealing with different medical insurance and vision plans can be very confusing. I can only imagine what it must be like from the consumer’s point of view – being that you may only use your benefits once or twice per year.
Often times a patient will come to our office with both a vision plan and a medical plan, and not know which insurance carrier will be responsible for the exam. In theory, it’s very simple. If your reason for coming to our office is for a routine check such as for glasses or contact lenses, then a vision plan is responsible. If you came in for a medical reason, such as dry eyes, a red eye or to follow your eyes for diabetic changes, then your medical coverage would be billed for the visit.
There is often a misconception that because we are Optometrists that we only file claims through vision plans. That is simply incorrect. We are contracted providers with most major medical plans and our training has allowed us to treat and manage complex medical conditions. We file your medical insurance just as a local Ophthalmologist or urgent care center would.
The problem with filing a medical visit through a vision plan is that they only reimburse for routine diagnoses (such as myopia, astigmatism, etc.) and will not pay us if you have a medical condition such as a red eye or an advanced cataract. Of course, even if we file your exam through your medical insurance, you can still use your vision benefits for glasses or contact lenses.
Our office does not make these rules– they are defined by the insurance carriers and vision plans themselves. We will do everything to work with our patients to help navigate through the maze the insurance system has set up. I hope this cleared up a little confusion regarding medical versus vision plans.
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