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.

Medical Insurance
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
  • Floaters
  • 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). 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. 
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*We are out of network for Humana insurance but are in network for most other medical insurance plans

Vision Plans
Vision plans are benefit plans that provide allowances towards glasses and contact lenses and will cover routine visits. An exam is considered routine when the only reported eye problem is blurred vision and the doctor determines there are no additional medical findings causing the blurred vision changes.  

*Sunrise Eye Care is in network with Blue View Vision; at this time we do not participate with any other vision plans. If you have another vision plan you may be eligible for reimbursement from your plan if there are not providers within your area who are in network with your specific plan.

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. 

Contact our billing department at Sunrise Eye Care or your insurance plan directly for any plan specific coverage questions.