Medical vs. Vision

Insurance in the world of eye care is confusing! We accept 2 types of insurance - medical and vision. All Americans must have medical insurance, but you may or may not have vision insurance.

Vision

Vision plans are designed to pay toward “routine” comprehensive eye examinations. A “routine” eye examination checks for, but finds no medical problems such as cataracts, diabetes, or glaucoma. The refraction test (determination of the eye’s prescription) is included, and since there are no medical problems, there is no discussion of problems or follow-up needed. Most vision insurance plans pay a portion of, or discount, eyeglasses or contact lenses.

Medical

Medical insurance pays toward eye care visits that are medical in nature. An emergency visit, or one focused on a specific eye problem, would be submitted to medical insurance. Some examples of a medical visit are: eye infection, floaters, eyelid styes, dry eyes, glaucoma treatment, loss of vision caused by a medical condition of the eye, etc.

Medical insurance may also pay toward a comprehensive examination if there is an ongoing medical reason for it (such as diabetes, cataracts, or any of the previously listed reasons). If there is a medical diagnosis, we are required to submit the examination to the medical, not vision, insurance. Believe it or not, a comprehensive examination that is medical in nature does not include the refraction. The refraction is billed separately and is the patient’s responsibility. Nearsightedness, farsightedness, astigmatism, and the need for reading glasses are not considered medical diagnoses. Medical insurance plans will deny this separate portion of the examination. If you have both medical and vision insurance plans, our office will coordinate the benefits to minimize your out-of-pocket costs.