How Do I Determine If My Insurance Has Vision Benefits?

InsurancePatients are often confused by the inherent details of medical insurance policies, but for those in need of eye examinations, the challenge of understand medical insurance may only be the beginning; navigating the world of vision insurance can be just as daunting.

It is possible for a patient to have both vision insurance and medical insurance plans, to have medical insurance alone, to have medical insurance that includes routine vision coverage without a separate vision insurance plan, and to have vision insurance alone and without a medical insurance plan. The human resource department of the employer providing your insurance benefits should be able to give you specific details on your coverage. If your questions aren’t answered, the easiest way to clarify your benefits would be to simply call the number on the back of your insurance card and ask about your coverage. When contacting both medical and vision plans, ask the following questions (and have a pencil and paper ready!):

Do I have routine vision coverage?


Are glasses a benefit, and how much does my plan cover for a frame and/or lenses?


 Are contact lenses a benefit?


Does My Medical Insurance Cover an Eye Examination for medically related complaints, even if I have no routine vision coverage?

In general, policy holders can usually expect to receive medical approval for eye exams or visits, even if a routine vision examination Eye Examination is not a benefit, when said exams are prompted by complaints related to an ocular medical condition. For example, if a patient visits with a symptom of blurred vision that is determined to be caused by cataracts, that visit is then billable to most medical insurance plans. Diabetic patients’ examinations are also often billable to most medical insurance plans. However, as with any medical visit, copayments, coinsurances, and deductibles will still apply. Also, if your insurance plan requires that you get a referral for specialist services, you must obtain a referral from your primary care physical prior to your visit. Other examples of conditions related to medically billable visits include dry eyes, eye infections, ocular foreign bodies, and ocular allergies. Again, contact your medical insurance using the number on the back of your medical insurance card and ask the following questions:

Can I get a vision examination related to my medical condition?

Always remember that you are best served by investigating your insurance coverage yourself, prior to your appointment, since you are ultimately responsible for the bill for your visits.


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