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Vision Insurance, Health Insurance and Eye care

Vision Insurance, Health Insurance, and Eye Care

Many of our patients have vision insurance, health insurance, or both. What’s the difference, and when do they come into play for eye care?

Insurance companies have divided eye care into two distinct areas: vision care and medical eye care. Let’s look at these individually:

 1.Vision care involves updating glasses or contact lenses. It covers conditions such as myopia (nearsightedness), hyperopia (farsightedness), presbyopia (“my arms are too short!”), and astigmatism.

2.Medical eye care involves a wide range of eye conditions. Some of these are not thought of as “diseases” in a traditional sense. Examples of these milder conditions are eye allergies and dry eyes. Medical eye care also covers more significant conditions such as cataracts, glaucoma, eye injuries, or infections. The list goes on and on!

So vision insurance covers glasses and contacts, and health insurance covers eye “diseases.” Simple, right? Actually, here’s where it gets tricky. Many medical eye conditions can cause vision changes that are corrected by glasses or contacts. For example, cataracts can cause a change in your glasses prescription before they progress to the point of needing surgery. So a medical eye condition (cataracts) may be addressed with vision correction (glasses).

As you can see, the division between vision care and medical eye care is not always clear. Dr. Lesnick,Dr. Dearing and Dr. Scheinker are professionally obligated to assign responsibility to your insurance company based on the primary cause of your eye problems, or the primary diagnosis that they detect. Of course, we are happy to work with you to keep copayments low and maximize your insurance benefits. However, this must be done within the framework of insurance billing regulations.

One more point to consider- what if you only have health insurance but no vision insurance? If you have previously been diagnosed with a medical eye condition (or suspect you may have one), your health insurance may pay for a medically necessary visit. If this describes you, ask us to help you understand your benefits.

Note: This summary is for educational purposes only and is not meant to be an official explanation of your insurance benefits. If you have questions regarding your insurance coverage, we encourage you to contact your insurance company directly.