Vision Benefits and Medical Insurance: What's the Difference?

We have patients that have both VISION BENEFITS and MEDICAL INSURANCE. They are very different in terms of the services they cover and it's important for our patients to understand these differences.

Vision Benefit (VSP, Spectera, Eyemed) is designed to determine a prescription for glasses and contacts and help pay for some of the cost of either glasses or contacts. Think of vision benefits as a "discount plan" for glasses and/or contacts - certain copays and overages will apply. These copays are set by your insurance plan, and we must comply with them.

Vision benefits are NOT equipped to deal with complex medical conditions and/or diagnoses. It does allow for screenings of these medical conditions, but once they are determined, then medical insurance is filed on those services. 

Medical Insurance (United Healthcare, MVP, etc.) covers office visits and/or procedures for medical conditions that affect the eyes. When a medical eye or health condition is present (such as diabetes, cataracts, dry eye, floaters, eye emergencies, etc) it is necessary to file the visit with your major medical insurance and the copays and deductibles for that insurance will apply as well as any non-covered service fees.

Vision Benefits and Medical Insurance usually cannot be used on the same day - because of this rule, you may have to return for a follow up visit if your eyes require further medical examination or treatment beyond the scope of your routine vision benefit coverage.

Insurance Carriers set these rules and our office is obliged to follow them

We make every effort to be on most major carriers for your convenience and we will file those claims for you. 

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Don't see your insurance company listed?

In the event that we are not on panel for your insurance company, we would be happy to provide you with an itemized receipt so that you may file with your carrier for reimbursement. If you have any questions regarding this topic, please let us know.