If you do not see your plan listed here, please contact us and we will be happy to look into your coverage.
Vision Insurance FAQ’s
Vision Care Plans are often an add on rider of your Medical Insurance intended to pre-pay and provide a service at a reduced fee. These plans are limited to a refractive diagnosis with the doctor performing a screening evaluation of the health of the eye. Vision plans such as VSP, Davis Vision, or Spectera cover vision diagnosis known as nearsighted, farsighted and some forms of astigmatism.
Medical care involves situations where during the course of the evaluation, a medical condition that requires a management decision related to your eyes is made. In these situations there is a need or indication for counseling, documentation, follow-up care, monitoring and prescription of medications or referral to a surgeon.
1. What does my Vision Plan (VSP, Davis, etc.) cover?
Your vision plan is intended for “well eye” exams. This includes your eyeglass or contact lens prescription and a screening for eye diseases / disorders and no medical decision or management is required. Most vision plans are limited to one office visit per year and does not typically cover contact lens fitting.
2. What does my Vision Plan NOT cover?
Vision plans do not cover medical eye care (floaters, dry eyes, allergy, lazy eye, vision loss, red eyes, infections and such). Select plans offer coverage of contact lens fitting but most do not.
3. What does my Medical Insurance cover?
If you are having a problem with your eyes or vision that is found to be caused by a medical condition or problem, then your exam is considered medical care. For example, if you are having difficulty seeing with your glasses and the doctor finds that your blurry vision is caused by cataracts, then your exam is medical care. Likewise if there is a need to prescribe any medication to treat any condition.
If you have a pre-existing condition or any disease that can affect vision or cause blindness (cataracts, glaucoma, dry eye, diabetes, high blood pressure, cholesterol, etc.) then your exam may be considered medical care. These services would then be covered by your major medical insurance. We are providers for many Medical panels including Medicare, Medicaid and other health plans. Medical Insurance does not cover glasses or contacts or services related to eyeglasses and contact lenses.
4. How do you decide whom to bill? Can I decide beforehand?
No, the patient does not have the medical knowledge and the doctor does not know beforehand.
At the time of service, we require information for both entities (Vision Plans and Medical Insurance). Once the doctor has evaluated you, the billed entity is determined by the final diagnosis and treatment plan (what you have and what we are going to do).
5. Why is this so complicated?
We must follow rules that are set by our contract with your insurance company.
6. Can I use my Vision Plan and Medical Insurance the same day?
Even if your eye exam is billed to your medical insurance, you may still use a vision plan benefits to purchase eyeglasses or contact lenses that same or a later date.
7. I still have questions…
We would be happy to answer any questions that you may have about your insurance coverage. You may also want to consult with your insurance company, vision plan, or human resources department.
Be mindful that until the doctor evaluates you, there is no way of absolutely determining which coverage will apply.