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News From The Billing Front Lines

By Dawn Deppe, Office Manager and Billing Expert

How To Use Your Vision and Health Insurance Plans at Restore Eye Care

Did you know that there is a difference between a vision benefit plan and a health insurance plan? There is, and it’s worth taking a few minutes to familiarize yourself with the difference.

Vision benefit plans as a rule are very basic, whereas health insurance plans tend to be much more comprehensive. However, the health plans tend to carve out vision and dental care, which is where the vision benefit plan comes into play. Vision benefit plans are there to help cover the cost of an annual eye exam and materials. You vision plan may not cover the cost of specialty medical testing, or additional office visits to address more complex concerns. On the flip side, your health insurance plan may not cover annual eye exams unless you have a specific medical condition that requires close monitoring. They also may not cover the cost of a contact lens evaluation or materials, again, unless they are required for a specific medical condition. However, your vision plan may cover these expenses. At Restore Eye Care, our job is to provide you with the proper care and assist you in understanding and utilizing your vision plan and health insurance benefits.

When any patient asks the staff here at Restore Eye Care if their visit is covered, and if it’s through the health plan or the vision plan, we usually ask a few questions about the reason for the visit. If you have an eye injury or infection, or an eye disease such as glaucoma or macular degeneration, or if you are a diabetic, have diabetic retinopathy, cataracts, or a previous history of eye surgery, your visit will likely be considered under the health insurance plan. However, if you require glasses or contact lenses, your vision benefit plan is usually the correct plan to use.

Vision care is not really defined by any routine set of rules, so it’s not possible to say with certainty that a visit will be covered by one plan or another until you are actually seen by the optometrist. Other variables include the plan benefit limits such as one pair of glasses per year or every two years, or if the benefit has already been used for that year. Sometimes, benefits change year to year, or change to a different company, or are discontinued altogether.

Many people believe that once they have a health insurance plan, they are covered for every possible scenario. This isn’t always the case. The bottom line is, check what your benefits are, look into the details, and ask questions if you don’t understand something. The staff at Restore Eye Care are always available to answer your questions regarding your benefits. We want you to receive the best in vision care, and that includes helping you navigate the sometimes confusing world of insurance. Call Restore Eye Care today for an appointment and see how we can help you.