What is the difference between medical insurance and a vision plan?
There can be a lot of confusion when multiple insurance types offer various coverages towards your eye exam. To help with this confusion, here is how we determine which of your plans we are able to use to cover towards your eye exam.
Your health insurance will generally cover eye-related medical problems that are pre-existing or discovered during your eye exam. Some examples include:
- Eye diseases (glaucoma, macular degeneration, cataracts)
- Diabetes, hypertension
- Eye infections
- Ocular allergies
- Dry Eyes
- Irritation or foreign body
- Retinal lesions (choroidal nevus)
- Vision changes related to an eye condition
If your doctor needs to explain, test, treat, monitor, or refer you for any medical eye conditions your visit will be billed to your medical insurance even if you also have a vision plan in effect. Expect to pay any medical insurance copays and deductibles at the time of your visit. You are still able to use your vision plan towards the purchase of glasses or contacts depending on your plan's allowances.
Vision plans are benefit plans that provide allowances towards glasses and contact lenses, and cover routine exams. A routine exam is one with no other noted problems beyond blurred vision, where your doctor finds no additional medical findings. If your routine exam reveals a medical condition or disease related to your eye, then your visit will not be covered by your vision plan so instead will be billed through your medical insurance.
Regardless of your plan, most insurances do not cover 100% of expenses. You should therefore expect some out-of-pocket costs which may include copays and deductibles as required by your insurance company.
We strongly encourage you to contact your insurance company before your appointment to make sure you are aware of your plans specific details. For any additional questions you may contact the billing department at Sunrise Eye Care and we will do everything we can to help you better understand your coverage.