Vision discount plans usually cover a routine eye examination every year or two. Medical conditions such as infections, red eyes, glaucoma or cataracts are treated separately--they are billed through the medical plan as often as is medically necessary. Many medical eye conditions cause no change to your vision or other symptoms in their early stages. Unfortunately in many cases, the doctor cannot tell if medical eye conditions exist before you are thoroughly examined.
What does my vision discount plan (EYEMED, VSP, Blue choice, etc.) cover?
Your Vision discount plan is intended for well-eye exams. This includes a refraction to determine your eyeglass prescription and a screening for eye diseases/disorders such as cataracts and glaucoma. Vision discount plans may include coverage or discounts for eyeglasses and/or for contact lens services and materials. Vision plans do not cover medical eye exams.
What is a medical eye exam?
If you are having a problem with your eyes or vision that is found to be caused by a medical eye problem, then your exam is a medical eye exam. For example, if you are having difficulty seeing with your glasses, and the doctor finds that your blurry vision is caused by cataracts, then your exam is a medical eye exam. If you have a re-existing condition (cataracts, glaucoma, dry eye, etc.) then your exam will be a medical eye exam.
Does my insurance cover medical eye exams?
Vision discount plans do not cover medical eye exams. However, these services should be covered by your major medical insurance. We are providers for Medicare, United Health Care, BCBS, Coventry and other health plans.
Why is this so complicated?
We have the same question, but are legally obligated to follow the rules that are set by your insurance company.
What else do I need to know?
Even if your eye exam is billed to your medical insurance, you may still use a vision discount plan to purchase eyeglasses or contact lenses.
You may also be responsible for paying annual deductibles and co-pays per visit on your health and medical insurance as well as co-pays when using your vision discount plan.
We will try to answer any questions that you may have about your insurance coverage, but you may also need to consult with your insurance company or your employer's human resources department.