Health insurance can be very confusing. We talk to patients about it everyday, so we thought it would be helpful to outline the basics.
We can’t stress enough that every plan is different. While you may be covered for a service, you may have a co-pay or deductible that must be paid. If you aren’t sure, please check with your human resources department or insurance company.
MEDICAL INSURANCE: Exams that qualify for Medical Insurance include care and treatment of eye disease and injury. Among the conditions covered are Glaucoma, Cataracts, Diabetic Retinopathy, Macular Degneration, Injury to the Eye, and Infection.
Most medical insurances do NOT cover the cost of checking to see if you need new glasses. This part of the exam is called Refraction (Better 1 or 2?), and is NOT part of medical eye care. Refraction is a separate charge.
VISION INSURANCE: Some benefit plans include vision insurance. Each plan’s coverage is unique, so you need to check specifics with your insurance plan. Items that MAY be covered under vision insurance at a reduced cost or co-pay include your routine eye exam, contact lens fitting, glasses and contact lenses.
Again, we recommend checking with your insurance company to verify your coverage, co-pay and deductible.
We are here to help if you need any treatment information or diagnosis codes so that you can discuss specifics with your insurance provider.
Ultimately, your insurance company considers you responsible to investigate your coverage and will often only provide that information to you, not to your doctor.