When it comes to having an eye examination, quite often there is confusion about how vision plans and medical insurance plans apply. It’s confusing for patients, and it’s confusing for the doctor’s office as well. This article will explain, in general terms, how vision plans and medical insurance is applied at your eye doctor’s office. For specific information on your particular vision or medical plan, ask you doctor’s staff and speak to someone at the vision or medical plan company.
Technically, vision plans are not insurance plans. Vision plans are designed to offer coverage for a basic eye exam and eyeglasses or contact lenses. These plans are for patients who do not need an evaluation for a medical problem. For example, a vision plan may apply if you need new eyeglasses or if it’s been a while since you had an exam and you want to make sure you see well and that your eyes are healthy. However, if you came to the eye doctor’s office because of a medical concern such as your medical doctor was suspicious of diabetes in the eye or cataract, an eye infection, or sudden decrease in vision for example, then the examination would be considered a ‘medical’ eye examination and the medical insurance would apply.
Many patients do not realize that their medical insurance may apply towards their eye examinations under certain circumstances. Unlike a vision plan, medical plans apply if there is a medical reason for the eye doctor to examine your eyes. For example, perhaps you’re having headaches or your allergies are acting up, or you have diabetes, etc. In those cases and other medical issues, the medical insurance would apply, and the vision plan would not. Most medical plans do not cover eyeglasses or contact lenses (unless they are considered medically necessary)
So, plan ahead….
When you make an appointment to see an optometrist or an ophthalmologist, make sure you ask if they take your vision plan AND your medical plan. The doctor’s office will help with the filing of your claim once they know which plan applies. Avoid confusion and ask the staff to help you understand your vision plan and your medical insurance.