Insurance Benefits Information
Today’s health care environment has become more confusing and complex. Understanding your health insurance and vision benefit is not as easy as it once was. The following information is provided to untangle and clarify many misconceptions about third party care and your vision:
Even if your provider (practitioner or health care facility) specifically takes assignment of benefits for an insurance or vision plan, the patient is ultimately responsible for any of the fees on non-covered services, deductible and co-pays. The insurance relationship is between the patient and the insurance company ― NOT between the patient and the provider.
Vision Plans only cover vision assessment and routine, well-care eye health evaluation. The most important aspect of the visit is to insure quality of life by providing you with a comprehensive, thorough medical examination of your visual system. Many eye diseases that affect your vision have little or no symptoms until the problem has become sight-threatening. Annual comprehensive eye health examinations are critical to prevent debilitating eye disease and vision loss as well as detect systemic conditions such as high blood pressure and diabetes.
It may be necessary for your doctor to perform additional special testing or procedures to insure the overall health of your eyes or treat and follow medical eye problems. Most often, this care will not be covered as part of your routine well-vision benefit. Major medical insurance may, in many cases, cover these tests and procedures as they are considered medically necessary. Deductible and co-pays will apply as with any medical care.
The following is a summary of the three major Vision Plans. Hopefully, this information will be helpful to all patients in choosing proper eyewear, contact lenses and eye care for themselves and their families. Please feel free to ask our administrative staff if you have any questions about your specific vision insurance or medical coverage during your visit. Our ABO Certified Opticians will be happy to determine if any out-of-pocket costs will be incurred at the time of your visit when purchasing eyewear.
Vision Service Plan (VSP) – In most cases, will fully cover routine eye health and vision exam. However, there may be a co-pay due at the time of service from the patient. The eyewear component of the Vision Service Plan contributes towards the purchase of your eyewear. Each specific Vision Service Plan subsidizes eyewear purchases at different levels, and patients are able to choose any frame or lens option recommended by their doctor that is available through our optical department. Contact lens services are generally not covered by VSP; however many plans offer a discount towards these services.
Davis Vision Plan – In most cases will fully cover your routine eye health and vision exam. However, there may be a co-pay due at the time of service from the patient. The eyewear component of the Davis Vision Plan contributes or subsidizes the purchase of your eyewear. Each specific Davis Vision Plan subsidizes eyewear purchases at different levels. The Davis Vision Plan does have frames that you can choose from with little or no additional cost to the patient. Davis has specific lens options available through their lab, and our opticians, along with your doctor will recommend the best option for your vision needs. Contact lens services are generally not covered by Davis Vision Plan; however many plans offer a discount towards these services.
Vision Care Direct
If you are not covered by a vision plan, our office offers an individual or group vision plan that can be purchased at the time of your exam called Vision Care Direct.
You can purchase the plan as a complete package of exam and material benefits or you can purchase the materials-only coverage which will subsidize the purchase of your eyewear. Each specific Vision Care Direct Plan can be purchased for coverage at different levels. Our professional staff will be happy to go over the different plans with you to determine which plan will work best for you and your family.
Our practice participates in the Medicare program. We accept assignment of benefits on behalf of each eligible patient. The eye health examination is a covered benefit under the Medicare program. However, as mandated by federal law, the refraction part your exam is a non-covered service. Each Medicare patient will be charged for the refraction, if performed. This charge must be paid for at the time of service along with deductible and co-pay. The purchase of frames, lenses, lens options and coatings is the responsibility of each Medicare patient.
Other Medical Plans
Presbyterian, United Health Care and Blue Cross Blue Shield of NM are the major insurance plans that our office is contracted with. Each plan varies in coverage regarding co-pays and deductibles that may be due from the patient. Our administrative staff will be happy to verify your medical insurance out-of-pocket expenses prior to your visit so that you will have a cost estimate of what your insurance does not cover and what will be due from you.
Hopefully, this information will give you a better idea of your vision benefit. Our administrative staff is available to answer any questions you may have. Due to the large number of different Vision Insurance Benefit Programs, it is impossible to know the specific details and reimbursement policies of each. If our doctors do not participate in your Medical or Vision Benefit Program, we will be happy to provide you all the necessary forms and documentation for you to submit to the carrier for reimbursement.
Thank you for your understanding and patience. We hope that this information on insurance and finance meets your needs. If you would like more information about whether we accept your plan, please feel free to contact us.