Our providers offer both medical and routine vision care, and the coverage between the two can vary.
Our ophthalmology team is not contracted with most of the routine vision plans, as they specialize in medical and surgical care. Please read to ensure you are scheduled appropriately for the type of coverage you anticipate being billed.
Your routine vison plan may be provider through a third party other than your medical plan, which may have a separate provider network. Please be sure you know the administrator of your vision coverage.
MEDICAL VS VISION INSURANCE EXPLAINED
What is Vision insurance, and how is it different from Medical insurance?
A Vision insurance policy is different from your health insurance policy.
Regular medical health insurance covers you for any medical eye concern, such as a red eye, infection, cataracts or glaucoma. Any diagnostic testing ordered to evaluate a medical condition would also be billed to medical insurance, just like testing ordered by your PCP or another specialist. Any exam, test, or surgery billed to medical insurance will be subject to your deductible and the co-insurance, or cost share, as determined by your specific plan.
In contrast, vision plans provide an added wellness benefit for healthy eye exams, which includes routine eye care, prescription eyewear and contact lenses, and other vision services at a reduced cost.
Some examples of vision insurance include Vision Service Plan (VSP), Davis Vision and Spectera/ United Healthcare Vision
What does vision insurance cover?
Most vision insurance plans include the following benefits:
· One annual routine vision exam
· Eyeglass frames & lenses
· Contact lenses
Benefits for glasses and/or contact lenses (sometimes called hardware or materials) vary. Most plans cover an amount toward one or the other, but not both.
What does my vision insurance NOT cover?
Vision plans do not cover any part of an eye exam considered “medical”. For example,
vision insurance will not cover vision loss, floaters, dry eyes, allergies, infections, eye
disease, or eye exams for complication from diabetes. If you need medication the doctor
will not be able to give you a prescription if you are using a vision insurance.
Some vision insurance plans do not cover contact lens fittings or include them as part of the overall material benefit.
Insurance coverage is a complicated issues and is constantly changing. If you have questions, please reach out to the office.
All of our providers accept the following insurance plans for medical services:
Traditional Medicare
Regence
Premera
Cigna
Humana
First Choice
United Healthcare PPO and Medicare Advantage plans-
We CANNOT accept UHC Community Plan
Our optometrists also take Vision Service Plan, Davis Vision (Boeing Plans Only) and Spectera/United Healthcare Vision.
Many medical plans carve the vision component of the plan to a third party carrier.
We may not be in network with those plans, even though we are in network with the medical as they create the provider networks separately. We are not in network with EyeMed, sometimes branded as CignaVision or AetnaVision.
As plans change over time, we always recommend reaching out to your plan to confirm coverage details.