Our insurance policy.

Most people have both medical insurance and vision plan. They are very different in terms of the services they cover and it is important for our patients to understand the differences.

When a medical condition is present, it is necessary to file the visit with your major medical carrier (Aetna, Blue Cross, Blue Shield, Cigna, Medicare, United Healthcare, UMR) and the co-payments for that insurance will apply. Insurance carriers set these rules and our office is required to follow them. In most cases, there is no way to know prior to the examination which type of insurance our office will be able to file for you.

Vision plan (VSP, EyeMed) is primarily for routine eye exams and the determination of glasses and contact lens prescriptions; it is not meant for complex ocular or medical conditions. Vision plan may allow for screening of certain conditions, but once they are determined, medical insurance will subsequently be used for further diagnosis and treatment.

Some VSP and Eyemed plans may help cover part or all your medical insurance out-of-pocket expenses. We may be able to help coordinate these benefits to bring down your payment.

1. If you have any problems or complaints that may be attributable to a medical condition which requires a more in-depth investigation and additional medical decision-making to rule out any underlying eye disease, we will bill your medical insurance, not your vision plan. These include, but are not limited to: new or sudden blurry vision, flashes/floaters, dry or itchy eyes, eyestrain, double vision, eye pain, redness, headaches, and loss of vision.

2. There are a variety of systemic conditions that can profoundly and permanently affect a patient’s vision that require a more in-depth investigation, which may include additional testing, follow up visits, and reports to your primary care physician. This type of examination is not covered under vision plans, and we will bill medical insurance, not your vision plan.

3. If you have previously been diagnosed by another eye doctor for conditions that require medical decision-making or management, we will bill your medical insurance, not your vision plan. These include, but are not limited to: cataracts, amblyopia/lazy eye, glaucoma, ocular hypertension, macular/retinal disease, and history of eye surgery.

We make every effort to be on every major carrier for your convenience and we will file those claims for you. In the event that we do not take your insurance, we will provide you with an itemized receipt so that you may file your carrier for reimbursement. If you have any questions, please let us know!