For patients planning their routine yearly eye exam, knowing the difference between vision insurance and medical insurance will help you understand the breakdown of what is covered at your next visit to the eye doctor.

Every vision plan is different and is separate from your medical insurance.

To start, medical insurance is not used during your routine yearly eye exam. In general, when you present your medical insurance at an optometry practice or office, it would be to cover any eye health exams, treatments or procedures that extend past the general examination given at a routine eye visit.

Vision insurance or eye care insurance is insurance that is used during the patient’s yearly examination that will cover their eyeglasses, contact lenses and general eye exam.

Knowing what services you seek will help determine how best to use your vision insurance plan. For instance, some vision insurance plans cover an eye exam with a pair of eyeglasses or a contact lense exam with a supply of contact lenses.

Many vision insurance plans do not cover both. Meaning if you get eyeglasses, the vision plan itself will not cover the contact lenses and vice versa. This does not mean the patient cannot get both or that they are not allowed to get both, just that their vision plan may not cover both.

To save time, it is advised that you know what your vision plan is prior to your appointment. Some vision insurance plans require prior authorizations. Others will outline what is covered and may give you a budget to work within.

Knowing ahead of time will save the patient from any surprises during their appointment. It is advised that the patient calls the office to confirm if we are in-network and accept their vision insurance.

If we do not accept the patient’s vision insurance plan or they incur expenses not covered by their plan, the patient can request an itemized receipt. Patient’s can submit the itemized receipt to their vision insurance plan for reimbursement if possible.

Patient’s scheduling appointments for eye treatments and therapies can expect to use their medical insurance instead of their vision insurance.

A patient being seen for an eye treatment or eye therapy will get specialized care for their particular need. These treatments and therapies are considered medical in nature.

Should the patient incur expenses not covered by their medical insurance, the patient can request an itemized receipt to submit for reimbursement if possible.

Our office accepts the following insurance plans:

  • Aetna HMO
  • Aetna PPO
  • Blue Cross Blue Shield PPO
  • Cigna PPO
  • PHCS
  • First Health
  • Cigna HMO
  • Eyemed
  • Superior Vision Plan (SVP)
  • Humana Choice Care Network
  • Medicare
  • Spectera
  • United Health Care
  • UniCare
  • Vision Service Plan (we are an out of network provider – please ask staff for details)

There are many insurance plans that we are out-of-network, and we are able to file your benefits. Give us a call at (972) 516-0026 and we will help you with your insurance questions.