Vision Plans and How They Work

VISION PLANS

Vision plans (or “vision insurance”) is one of the most misunderstood benefits of all health-related coverage. Some insurance companies do a better job of educating their clients than others. Insurance companies’ “customer service” departments at times overstate benefits, or are misleading (and minimize or even ignore specific limits and restrictions) that can create an adversarial relationship between the patient and the doctor’s office.

Although our staff members are very knowledgeable about insurance plans, remember that it is not the doctor’s or staff’s responsibility to know the details of your individual plan. It is to your benefit to be aware of all out of pocket costs.

SEPARATE RIDER POLICY

Many people with medical insurance have a separate rider policy or vision care attachments (“vision Insurance”) to cover routine eye exams. (A routine eye exam is a screening exam). Often the vision plan is under a different name.

Many times a patient arrives to their exam with little knowledge of their vision plan. We DO NOT bill or pre-authorize vision discount plans.  As a courtesy to the patients, Affleck, M.D. Eye Care WILL file a claim with your MEDICAL insurance.

Topic In This Article

• UNDERSTAND MEDICAL INSURANCE AND VISION PLANS
• WE INVITE YOU TO SEE DR. AFFLECK AND USE YOUR IN-NETWORK MEDICAL INSURANCE AND OUT OF NETWORK VISION PLANS.
• HIDDEN BENEFITS FOR USING DR. AFFLECK AND YOU VISION PLAN
• FOR INSURANCE PURPOSES, EYE EXAMINATIONS ARE DIVIDED INTO TWO CATEGORIES
• WHICH KIND OF EYE EXAM WILL I HAVE? Medical Eye Exam Vs Vision (Routine) Eye Exam
• COMMONLY ASKED QUESTION
• EYE TALK: Did You Know…

WE INVITE YOU TO SEE DR. AFFLECK AND USE YOUR IN-NETWORK MEDICAL INSURANCE AND OUT OF NETWORK VISION BENIFETS.

Dr. Affleck may be out-of-network with your vision insurance but not your medical.  The benefit is coordination of coverage!  Instead of going to your optometrist for your routine eye exam and then returning for a medical eye exam Dr. Affleck will be able to preform it all at once.  You will pay for the vision service of the refraction, then we will bill your medical insurance. Upon completion of the appointment, you only need to submit some paperwork to be reimbursed. Most paperwork is on-line and easy to complete.  From our experience many times your vision insurance reimburse you more than they reimbursed us.

HIDDEN BENEFIT

There are other hidden benefits to see Dr. Affleck for your eye exam.

1. You have Dr. Affleck full training and skills behind each exam.
2. If a medical issue does arise, Dr. Affleck can treat it without “returning” for another exams, co-pay and etc.
3. If the diagnosis from the exam is only about the need for glasses or no medical diagnosis we will give you the vision only exam price.
4. Vision plans pay eye providers significantly lower reimbursement for their services. Therefore, eye providers may rush an exam so they may see more patients to make up the deficient.
5.  Vision plans may encourage “short cuts” on exams or adding patient paying tests to make up the deficient. (We speak from experience.)
6. Products such as glasses and contacts may be over inflated to cover losses from vision plan reimbursements.

For insurance purposes, eye examinations are divided into two categories:

VISION EXAM: These exams have many names: routine, preventive, screening or “Wellness Vision” exams for people who have no eye disease or symptoms of disease but may need glasses or contact lenses. These exams do not allow any treatment. If Dr. Affleck finds anything abnormal during your vision exam, further testing of a medical nature may be needed and treatment given. In that case, your medical insurance would be billed.

MEDICAL EXAM: This is a medically necessary comprehensive examination for the diagnosis and treatment of diseases and conditions of the eye. This exam evaluates the reasons for the symptoms and assesses any treatment needed. Some conditions evaluated with medical eye exams include cataracts, glaucoma, diabetic retinopathy, macular degeneration and many other potentially sight-threatening diseases.