VISION VS MEDICAL INSURANCE

What's the Difference?

Eye Exam
Doctor Using Digital Tablet

WHEN TO USE VISION INSURANCE

Vision plans provide coverage for routine exams, glasses, and contact lenses, or provide a discount on the doctor’s fees. If you have trouble with your vision (nearsightedness, farsightedness, astigmatism, etc.), your visit is considered a vision problem and can be billed to your vision plan.

Vision Insurance covers annual wellness visits where typically the only complaint is blur and that blur is fixed by either glasses or contacts. These visits are similar to seeing your primary care doctor for your physical exam, and generally do not allow for us to provide medical services such as special testing, prescription eye drops, or other in office treatments. The nice thing about vision plans is that they generally have no deductible, and instead have set copays for exams and glasses/contacts.

WHEN TO USE MEDICAL INSURANCE

If you have a medical problem (eye infection, eye injury, diabetes, cataracts, glaucoma (suspect), dry eye, double vision, etc.), your visit is considered a medical problem and can be billed to your medical plan.

Medical Insurance requires visits to be complaint driven. This means that these exams serve the purpose of addressing a specific medical eye problem, but they can also serve the purpose of a comprehensive eye exam for patients with certain conditions or medications that require annual eye exams such as diabetes or plaquenil (a medication often used for rheumatoid arthritis). Examinations that are billed towards a patient's medical insurance plan, can still utilize their materials benefits (eyewear/contact lenses) through their vision plan.
 

 
 

©2020 by Dr. Thomas Tsai, O.D., PLLC & Associates.