Vision vs Medical Insurance: Which do you use?

Vision vs Medical Insurance: Which do you use?

Insurance benefits can be helpful in reducing healthcare costs.  However, they can be very confusing, especially when it comes to eye care, and whether you can use your medical or vision plan.  You can use both insurances at your optometrist’s office, but which one you use depends what type of visit it is.

Your vision plan can be used for any type of comprehensive eye exam or preventative exam that would check the health of your eyes and you would also be provided glasses and contact lens prescription, if necessary.  During this visit your optometrist may incidentally find signs of certain conditions, such as glaucoma, allergic conjunctivitis, or even dry eye syndrome.  These would all be considered a medical condition and can not be treated using your vision plan.  Therefore another visit would be necessary to use your medical plan.

Your medical insurance will cover any type of treatment for a disease or condition that’s affecting your eyes.  This is the same insurance you would use to see your primary care physician.  Just as you would make sure your primary care physician is in network with your insurance, you would do a similar search for your optometrist. Not only can you use your medical insurance for the conditions stated earlier, glaucoma, ocular allergies, and dry eye syndrome, you can also be seen for ocular infections, trauma, or flashes and floaters. These visits will be covered by your specialist co-pay.

Medical insurance coverage is somewhat generic in that they will cover a particular testing no matter what type or brand of equipment that is used.  However, vision insurance does not follow the same rule.  Depending on your plan certain brands of lenses or frames are not at all covered and would have to be purchased out of pocket even if you go to a provider that is credentialed with that plan.  Certain vision plans also dictate which laboratories should be used to make the lenses and sometimes the process can take much longer than a lab your optometrist would choose.  Just as you would choose to see a primary care physician that is out-of-network with your insurance, you can do the same with your optometrist.  You can get the exam and purchase glasses from an office that may not take your insurance and either they or you can submit the claim to get reimbursed for the exam and glasses you purchased.

Healthcare has always been a complex topic, more so than it needs to be.  If you have any questions about which insurance to use, or if you would like to know if you are eligible for certain benefits, do not hesitate to reach out to our office.  We would be more than happy to help!



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