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Vision Insurance vs Medical Insurance

Will the confusion about insurance ever end? Maybe not, especially with all the changes coming next year.Those changes are the subject of a future blog. But for now, perhaps I can offer some clarity on the state of insurance as it is currently.

Eye care is the only specialty with two insurances and that is the source of confusion.

The vision insurance covers some of the cost of materials–the eyeglasses and/or contacts as well as a refraction of the eyes.

The medical(or health) insurance covers some of the costs for the diagnosis and treatment of diseases–management of eye health. Remember, the eyes are part of the overall body and are susceptible to illness just as other parts of the body are.

The optometrist is a primary care provider for the eye. We are trained to do just about everything for the eyes. We refract the eyes for clear vision. We diagnose and treat diseases of the eye. We write prescriptions for topical and oral medications(like the ophthalmologists). We can also sell eyeglasses(just like opticians and some ophthalmologists). We do not provide secondary services like surgery or any other invasion treatments.

Ultimately, it is the doctor that makes the decision as to what is needed for the patient and thus which insurance is billed. In general, the following scenarios should help in understanding the difference between the two insurances.

If a patient is visiting the office to check if diabetes has affected their eyes then the medical insurance is billed. It is the same as when they go to the medical doctor for diabetes.

If a patient is visiting the office because the eyes feel sandy because of the medical condition known as dry eye then the medical insurance is used.

If patient who visits the office has spring allergies which cause their eyes to itch then the medical insurance is billed.

If a patient visits the office and just needs an exam for new contacts/glasses then the vision insurance is billed.

If the patient above returns tothe office with an infection from wearing contacts then the medical insurance is billed.

You get the idea. Hope this helps…..