Understanding Insurance Coverage:
Probably one of the most difficult things about "getting your eyes checked" is understanding your insurance coverage. You find VSP, VCP, PPO, HMO, POS, Select, Choice, Open Access and almost every combination of "alphabet soup". It is very confusing.
In general, insurance related to the eyes falls into three categories: Medical Care, Well-Vision Care, and Medical Care with a vision rider. All of our routine eye exams include a visual exam portion (glasses or contacts) and a health exam portion. Many patients do have medical conditions like dry eyes, cataracts, or allergies.
Medical Care plans (like Medicare) pay for medical (disease) and emergency problems in the eye system, such as cataracts, dry eye syndrome and eye redness or pain. Even allergies can be a "medical" reason to get your eye exam covered with your medical insurance. Medical Care plans allow coverage as often as "medically necessary" for treatment of the eye disease, often more than once per year. Without a vision rider, medical plans generally do not cover routine (non-disease) visits or glasses and contacts. Many of the CIGNA, United Health Care, PacifiCare and Blue Cross/Blue Shield plans are Medical Care plans.
Well-Vision Care plans, often called "eye-glass" programs, pay for routine visits and glasses/contacts and generally allow coverage once per year. Although eye disease can be monitored, treatment of eye diseases and emergencies are only covered when the plan contains a primary or acute care rider. VSP, CompBenefits and Cigna Vision are Well-Vision Care plans.
Medical Care plans with a vision rider are really a combination of the other two types and pay for disease and routine care. Although the most common vision rider is VSP, many other smaller plans exist.
Believe us, we know it is confusing. If you have any questions, please call our office. We will do our best to try to help.