We get many questions from patients about insurance coverage, so we want to help clarify the differences between medical coverage and vision care policies and what these mean to you.

 There are two types of health insurance that will help pay for your eye care services and products:

• Vision care plans (such as VSP and EyeMed)
• Medical Insurance (such as Anthem, Aetna and Medicare)

 

Vision care plans only cover routine vision exams, along with the purchase of eyeglasses and contact lenses. They cover only a basic screening for eye diseases, and eye exams to determine if you need a prescription for eyeglasses and/or contacts. They DO NOT cover management or treatment of eye diseases.

Medical Insurance can be used if you have any eye health problems or systemic health problem that has ocular complications (which your doctor may need to determine). These include:

• Dry eyes
• Pink eye
• An eye injury
• Flashes or floater in your vision
• Cataracts
• Glaucoma
• Complications from diabetes, high blood pressure or other health concern

 

If a medical complication is determined during one of our comprehensive eye exams, your medical insurance will be billed. You do not need a vision care rider on your medical insurance for this to occur. It’s the same as seeing any other doctor – you pay a copay/deductible, and the medical insurance provider is billed.

In some cases, we can bill some services to your medical insurance and other services to your vision care plan. We will work with you to properly coordinate benefits to minimize your out-of-pocket expenses. For example, if it is determined during an exam that you have a medical condition, we can bill it to your medical insurance provider; however, you may still purchase eyeglasses and contacts using your vision care plan.

Crozet Eye Care will try to obtain advanced authorization of your insurance benefits so we can tell you what is covered. If you are using an out-of-network policy (for vision care or medical insurance), you will be asked to pay the amount due in full at the time of your service. We will still file the claim with your insurance company, and then they will send you a check for the reimbursement amount (for whatever amount they decide this will be). So, just because you have a vision care plan that we do not accept does not mean you have to pay 100% of your bill. You may be reimbursed for your visit, but it is up to each insurance provider to determine what that amount will be.

This is a confusing and frustrating topic for many, so feel free to ask us all of the questions you need to feel comfortable. Again, we will work with you to determine how to minimize your out-of-pocket expenses while staying within the insurance guidelines. Our mission is to make you AND your eyes happy!

For a list of the insurance providers with which we participate, please scroll to the bottom of this web page. If your insurance is not listed, please call us for more information.