We often have patients that have both vision insurance (for example, VSP or EyeMed) and medical insurance (for example, Blue Cross, Aetna, Blue Shield, or Medicare), and it can be confusing as to which makes the most sense to use when it comes to your eye care. We get it! And we always try our very best to help our patients understand the differences.
- Designed mainly to cover determining a prescription for glasses, to help pay for glasses or contact lenses, and to cover a yearly routine evaluation of the health of the eyes in a healthy patient that has no particular problems or symptoms.
- It is not equipped to deal with and does not usually cover medical conditions, injuries, and/or treatments.
- Designed to cover you when you have a medical problem, including one that affects your eyes.
- Medical insurance does not cover routine vision services or examinations for glasses, or routine vision problems such as nearsightedness, farsightedness, and astigmatism. Those are only covered by your vision insurance.
When There’s A Medical Diagnosis
- When a medical diagnosis or medical condition is present that affects your eyes, such as high blood pressure, high cholesterol, or diabetes, to name just a few examples, or you have an eye disease or eye problem such as an infection (pink eye), dry eyes, allergy, or cataracts, again, just to name a few, we must file the claim with your medical insurance, and the co-pays and deductibles for that insurance will apply.
- Your vision plan does not cover these kinds of problems. Unfortunately, we don’t get to make our own rules on this topic or bend the ones that are in place. They are made by the insurance companies themselves, and we must legally comply with them. But we will always try our best to explain these details to you while you are in our office.
Which One Is Right?
- There is often no way to know prior to your examination which type of insurance will be the right one to file your claim with.
- We make every effort to join as many insurance panels, both medical and vision, as we can for your convenience.
- If we are on your insurance company’s panel, we will file those claims for you.
- In the event that we do not accept your medical or vision insurance, we will provide you with an itemized receipt so that you may file a claim for reimbursement with your insurance company yourself.
- We are here to help in any way we can; please don’t hesitate to reach out to our office at 239.936.4706 should you have any questions!