The landscape of health care delivery and medical insurance practices has changed greatly over the last few years. Many of our patients now have high-deductible plans, significant copays and restrictions on their coverage. It is a challenge for patients and doctor’s offices to keep track of and understand these changes. We strive to work with our patients in providing optimal care and to work with insurance companies on your behalf.
Routine vs. Medical Office Visits
Some insurance carriers will cover your visit with an Ophthalmologist for a “medical” reason (for a specific eye problem) but not for what they call “routine” (healthy) eye care. Other carriers cover “routine” eye exams with an Optometrist and limit the frequency to 12 or 24 months.
When asking about “medical” and “routine” coverage, it is very important to ask if you are covered under a separate vision plan for “routine” eye care (e.g. EyeMed, VSP).
Insurance varies widely and we often cannot discern your level of coverage by looking at your card. It is your responsibility to understand your specific coverage before your visit.
Please ask your carrier if you are covered for “medical” and/or “routine” exams so that you know what will be covered, and so that we can schedule you with the appropriate provider.
If your insurance requires a referral, you need to obtain one BEFORE your visit. As a courtesy to our patients, we bill insurance companies on your behalf. However, if we do not have a valid referral on file at the time of your appointment, the claim will not be paid and you will be responsible for payment.
Traditional Medicare plans DO NOT require referrals while some replacement and supplemental plans do.
If you are a Medicare patient, it is important for you to know that Medicare and Medicare replacement or supplement plans do not cover “refractions”. A “refraction” is the process that determines the prescription for your glasses. The fee for this service is $50.00 and is collected at the time of your visit. If you do not wish to have a refraction, please let us know.