Most people have vision coverage and medical insurance. They are very different in terms of services they cover, and it is important for our patients to understand these differences.
Vision coverage (VSP, Avesis, etc.) is mainly designed to determine a prescription for glasses and is not equipped to deal with more complex medical conditions and/or diagnoses. It does allow for screening for conditions, but once they are determined your medical insurance is filed on those services.
When a medical condition is present (such as diabetes, cataracts, dry eye, floaters, etc.) it is necessary to file that visit with your major medical carrier (BCBS, UHC, Aetna, etc.). The co-pays for that insurance will apply as well as any non-covered service.
Insurance carriers set these rules and our office is obliged 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. We make every effort to be on every major carrier for your convenience and we will file those claims for you. We will provide you with an itemized receipt if we do not take your insurance so that you may file with your carrier for re-imbursement. If you have any questions, please let us know.
It is the patient's responsibility to understand her/his insurance and what is covered under his/her wellness eye exam benefit.