WHAT IS VISION INSURANCE?
A vision insurance plan differs from regular health insurance because it is a wellness benefit that helps defray costs of eye exams, eyewear, contact lenses, and other vision services. This type of insurance typically provides for routine, preventative eye care (aka “Healthy Eye Exam”). Examples of vision insurance plans that our office provides services for include: Vision Service Plan of America (VSP), Vision Benefits of America (VBA), and Davis Vision.
UNDERSTANDING PROVIDER NETWORKS AND VISION INSURANCE PLANS
- Vision insurance plans offer similar benefits from one to another, but may vary in important ways such as in how many providers are included in the approved network that offers eye exams, eyewear, and other services. Also, vision plans may differ depending on whether services are discounted or offered as part of a benefit package.
- Vision benefit packages provide participants with specific eye care services in exchange for an annual premium or membership fee.
- Basic coverage includes an eye examination and a pair of eyeglasses or contact lenses. Allowances may or may not be given for designer frames, specialty lenses, and LASIK or other refractive surgical procedures.
- Often, a participant must pay a co-pay, which is a fixed dollar amount, each time they access a service from a network provider. Usually, limits are put on the number of times a participant may access services (typically 1 time per year).
- The premium or the membership fee amount depends on the level of coverage the plan provides – full service, eye exam only, or materials only. The number of family members covered and the amount of co-pay also are factors that determine the premium amount.
UNDERSTANDING INSURANCE
VISION INSURANCE PROVIDERS
Typically, vision insurance companies contract with a network of eye care professionals to provide services to vision plan members at fixed rates. These rates sometimes can be reduced significantly below posted retail prices.
MEDICAL INSURANCE USED FOR EYE CARE
- Usually medical insurance is used if one has any eye problem or eye disease, or if any medical condition is present that is known to cause eye problems. The medical insurance can be utilized to diagnose and treat diseases of the eye.
- Some common conditions in which medical insurance can be billed for include (but are not limited to) the following:
- Monitoring cataract development
- Examination of patients possessing diabetes
- Examination of patients that are on medications that have a potential eye side effects – i.e. steroid based medicines, arthritic medications such as plaquenil, etc.
- Patients that possess high risk for glaucoma development
Please be sure to let us know the purpose of your visit when you schedule your appointment in our office to lessen the chance of confusion about whether the vision plan or medical insurance is the appropriate billing choice for your visit. Also, please provide all of your most up to date insurance cards/information (both vision and medical insurance plans) so that we can bill the appropriate insurance coverage for you.