Insurance Benefits Information

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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:

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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.

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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.

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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.

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