Vision Insurance vs Medical Insurance

These entities are quite different.  Please read this entire section on vision insurance vs medical insurance for a review of how your insurances will be used at our office.

The world of insurance can often be just as complicated for the medical provider as it is for you the patient and with the recent implementation of the Affordable Care Act, the world of insurance will be changing and evolving even further in the coming years.

At Precision Family Eye Care, our goal with this page, is to educate our patients to know how their insurances works for them and what services and products are covered and by what insurance.

Vision Insurances

Vision insurances cover a routine Complete Ocular Health Exam ONLY for refractive or glasses related problems.

Vision insurances are typically an add-on supplemental insurance that is provided as an option by either an employer, when purchased through the health care exchanges, or directly through an insurance carrier. There are many, many different possible vision insurances and our website shows which vision insurances we accept. If we do not accept your vision insurance we are still able to take care of you as patients for medical eye conditions through your medical insurance carrier.

All vision insurances will cover a Complete Ocular Health Exam with a copay or a percentage discount off the exam. From that point, the vision insurance may also cover or give a discount on materials (contact lenses or glasses) or pay a certain amount toward those materials with you, the patient, being responsible for any charges over that amount and/or required material copays as laid out by your vision insurance. Some vision insurance will also cover additional lens options like No-Line Bifocals or Antireflective Coatings, while others do not. The only way to know for sure what your insurance will cover or how much a pair of glasses will cost is for a staff member to look up what your vision insurance carrier covers, review what lens options your glasses require, and see for themselves. For a complete discussion and education on eyeglass lens options, please visit Demystifying Lens Options.

It is also extremely important to reiterate that vision insurance DOES NOT cover any ocular health issues or specialty testing associated with eye diseases (dry eye evaluations or treatment, glaucoma testing or treatment, eye infections, contact lens complication, etc.). Exams are only billable to vision insurances if they involve a refractive or glasses related diagnosis (nearsighted, farsighted, astigmatism, or presbyopia), otherwise they are billed to your medical insurance. Common complaints such as itchy eyes, dry eyes, and even headaches depending on the findings of the exam often result in the your medical carrier being billed for those visits. Which visits are covered by which insurance is determined by your reason for visit and by the findings of the exam and are not rules we have created but simply what is dictated to us by the Vision and Medical insurance companies. If an exam is billed to your medical insurance carrier, you are still able to use your glasses or contact lens vision insurance benefit toward the purchase of materials.

Medical Insurances

As discussed prior, vision insurances only cover office visits where the main diagnosis is a refraction related issue. If the doctors find an ocular condition or disease that requires treatment or further in office testing, that visit and all specialty testing and procedures are billable toward your medical insurance and is subject to any medical copays or deductibles associated with the medical insurance.

In addition, certain medical conditions require a higher degree of medical decision making which require an exam visit to be filed with your medical insurance. These additional situations include, but are not limited to ALL DIABETIC EYE EXAMS, certain high risk medications, certain neurological conditions, among other things. Our staff will do their best to make you aware whether you visit will be covered under your vision or medical insurance, but such things can change based on the exam findings and the reason for your visit.