Vision Plans and How They Work




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.


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.

Contact to brown eye

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.


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.

Medical Insurance


Medical insurance covers diagnostic and treatment programs of eye conditions, the prescription of medication, and arranging for special diagnostic and treatment services or laboratory and radiological services.

Vision Plan

Vision Plans

Mistakenly called vision insurance, vision plans are discount programs. They are not regulated and don’t follow the same rules as medial insurance companies. The exams have similar elements of a medical eye exam, however, they are a screening or preventive care.


Medical Eye Exam Vs Vision (Routine) Eye Exam

The kind of eye exam- “medical or routine” is not determined by

  • Who you see (an ophthalmologist or an optometrist).
  • Stating which insurance you want to use.
  • Even by the reason for the visit (at least with complete accuracy).

The eye exam type will be determined at the end of the exam with Dr. Affleck. The diagnoses determine the kind of eye exam.  Here however, are some common sign and symptoms that will normally, (but not always) be diagnosis as either medical or routine. Please call us with any questions.

which exam do you need2

I see flashing lights, like fireworks for several minutes a couple of times today.

Medical Eye Exam

I am OVER the age of 55 and have blurry eyes. It has been more than 2 years since I last saw an eye doctor.

Medical Eye Exam

I am around 40 years old and have blurry eyes. I have problems reading and seeing the computer.

Vision Eye Exam

My eyes hurt, they are red, and tear a lot.

Medical Eye Exam

My child's teachers, day care and myself has seen his/her eyes cross from time to time.

Medical Eye Exam

My child needs a good eye exam. S/he has been complaining about seeing the chalkboard at school.

Vision Eye Exam

I wear glasses and my glasses don't seem strong enough. I have not had an exam for a couple of years. I am healthy and under the age of 50.

Vision Eye Exam

Commonly Asked Questions

By law, Medicare does not pay for routine vision exams or refractions.

This depends on the reason and diagnosis for the visit: examinations for medical care, evaluation of an eye complaint, or to follow an existing medical condition are billed to the patient’s medical insurance. Examinations for the purpose of checking vision, screening for disease, or updating eyeglasses or contact lenses are billed to the patient’s vision plan, if the doctor participates in that plan.

Dr. Affleck does not participate in vison plans. The patient will pay that portion of the exam and then request their plan for reimbursement.

The simplest answer is if at the end of the exam, if all that is diagnosed is the need for eye glasses because you have a refractive error. (Meaning nearsightedness, farsightedness, astigmatism or  presbyopia) your medical insurance will not cover the charges. Your vision plan will provide some, but not all reimbursement.

Yes, Once a medical diagnosis is found (any diagnosis other then the need for eye glasses or refractive error diagnosis) by law the doctor must charge a medical eye exam.

Unfortunately,  the most common symptom of a refractive error is blurry vision. Other medical conditions have similar symptoms; glaucoma, cataracts, and dry eye just to name a few.  Only a dilated eye exam can determine if your blurry vision is a condition that eye glasses will correct or something more serious is effecting your vision.  Call us today to schedule an appointment. It all starts with an exam with Dr. Affleck 


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