Insurance: Medical vs Vision

Insurance equals confusion, especially in the world of eye care.  We accept 2 types of insurance, medical and vision.  According to the Affordable Care Act, everyone must have medical insurance.  Your health insurance may be provided by your employer, or you may purchase this insurance yourself.  You may or not have vision insurance in addition to your medical insurance.  


Vision insurance is designed to pay toward "routine" comprehensive eye exams.  A "routine" eye examination checks for, but finds no medical problems.  The refraction (determination of the eye's prescription) is included, and since there are no medical problems, there is no discussion of problems or follow-up needed.  Most vision insurance plan do not pay towards the contact lens portion of the examination (Contact Lens Care), but may offer a discount on these services.  Vision insurance plans often pay a portion (or offer a discount on) eyeglasses or contact lenses.  


Medical insurance pays toward eye care visits that are medical in nature.  An emergency visit, or one focused on a specific eye problem, would be submitted to medical insurance.  Some examples of a medical visit are: eye infection, floaters, eyelids styes, dry eyes, glaucoma treatment, loss of vision caused by a medical condition of the eye, etc.  

Medical insurance may also pay toward a comprehensive examination if there is a medical reason for it (such as diabetes, cataracts, or any of the previously listed reasons).  If there is a medical diagnosis, we are required to submit the examination to the medical, not vision.  Believe if or not, a comprehensive examination that is medical in nature does not include the refraction.  Nearsightedness, farsightedness, astigmatism, and  the need for reading glasses are not considered a medical diagnosis.  Medical insurance plans will deny this portion of the examination.  If you have both medical and vision insurance plans, our office will check to see if coordination of benefits are available to minimize your out-of-pocket costs. 


Below we have included both medical and vision insurance plans that we accept.  

Advantage GHP Blue Cross Blue Shield Plans
Care Improvement Plus Cigna
EyeMed Standard Plans First Health/Coventry
Great West Group Health Plan (GHP)
Healthcare USA Healthlink
Medicare Mercy Health Plans
Missouri Eyecare Alliance (MECA) MO HealthNet (Medicaid)
MissouriCare National Vision Administrators (NVA)
HomestateHealth/Envolve Optum Health/Spectera
United Healthcare UMR
Vision Care Direct Vision Care Plan
Vision Service Plan (VSP) Delta Vision (Advantica)

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