There’s almost nothing more important to your well-being than clear vision and healthy eyes. And there’s almost nothing more important to your budget than making sure that you use your health insurance benefits correctly. Unfortunately, patients rarely understand how their eye and vision insurance works. Here’s a quick two question quiz on this topic:
1. Jessica is in pain because something got in her eye while she was out running. She has medical insurance but because she doesn’t wear glasses or contacts, she elected not to take the vision plan addition to her medical insurance. Which of the following is correct:
A. Since Jessica does not have a vision plan, she does not have insurance coverage to see an eye doctor to remove the particle in her eye.
B. She has eye coverage if she sees an eye doctor on her medical insurance plan.
Correct answer: B
Vision Insurance generally provides for a once a year visit for a routine annual eye examination. It does NOT cover medical eye emergencies or treatment for eye disease. However, your medical insurance — even if you do not have vision insurance–-will typically cover a medical eye condition (assuming you have met your deductible).
2. Jeremy has a vision plan and a medical health insurance plan. His vision has gotten blurry and his eyes are frequently red and irritated. He had to stop wearing his contact lenses but wants a prescription for new contacts and glasses. Jeremy is concerned that he has recently started seeing floaters in his vision. Which of the following is correct:
A. Jeremy’s Vision Plan will cover his examination for irritated eyes, blurry vision, new contact lens prescription, eye glasses and floaters.
B. Jeremy’s new glasses and contact lenses will be covered by his vision plan.
C. Because he has a vision plan he will not have any charges for contact lens fitting services.
D. None of the above.
Correct answer: D None of the Above.
Jeremy has multiple medical eye problems (eye irritation and floaters) and multiple vision needs (eyeglasses and contact lens fitting). He may need two or three visits. He would probably use his Vision Plan for one visit and his medical insurance plan to cover additional visits related to the red eye irritation and floaters.
If Jeremy uses his Vision Plan to purchase eyeglasses, he may have additional fees for glasses if he upgrades from the basic frame and lens choices provided by his vision plan. And, if he used his VIsion Plan to purchase eyeglasses, in most cases he would need to pay out of pocket for contact lens fitting / evaluation and for his contact lenses. If he uses his Vision Plan for contact lens fitting, he will need to pay out of pocket for eyeglasses.
Even though contact lenses are not covered under medical eye insurance, if you have a contact lens related complication that causes infection or eye pain, it may be covered under your medical insurance and not your vision plan.
And there are a few medical insurance plans that do cover an annual eye examination, even if you do not have a Vision Plan, and even if you do not have a medical eye problem.
GH Eye accepts VSP, EyeMed, Anthem, Care First, United Health Care, Aetna and other plans. As part of our service to the community, we will help you research your eye and vision care benefits coverage.
For patients who do not have vision plans, or who want to fill in the gaps of their vision plan coverage, we offer our exciting GH Eye Club program.
Perhaps the most important aspect of care at GH Eye is that we co-ordinate your vision and medical eye care — both in terms of the examination services you need to protect and preserve your vision, and in terms of your insurance. We care for your eyes AND your vision.
GH Eye is conveniently located for patients who live in Gainesville, Haymarket, Warrenton, Manassas and surrounding areas. We have morning appointments available as early as 7 AM for early birds; late afternoon appointments and Saturday appointments. Come visit!