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Insurance FAQs

Remember the Rule of Thumb: Always check the details of your benefits package regarding your vision and medical plans with your provider and/or employer.

Q: What kind of insurance do you accept?

Answer: We accept the following vision insurance plans, which will cover a certain portion of your annual exam and materials in most cases. See your specific plan for details.

  • VSP
  • Eyemed Vision Care Plans

For medical visits (anything outside of a routine exam – see distinction below), we accept the following insurance plans. Please note we do NOT accept the HMO plans for any insurance.

  • Cigna
  • Aetna PPO
  • Humana PPO
  • United Health Care PPO
  • Medicare

Q: Do I need to bring my insurance card?

Answer: We do ask that you present and verify your medical insurance at each visit, just like you would at any doctors’ office. We know that some vision insurance plans do not give out cards, so we may just verbally ask you if your benefits are the same from your last visit.

Q: What information do you need to verify my insurance?

Answer: At minimum, we need the following information 24 hours before your appointment – sooner is much appreciated! This allows us enough time to verify your benefits and gives us time to notify you of any issues and solve them before your visit. For more on verifying benefits, please see the information below.

  • Name of your vision insurance company
  • Name of your medical insurance company (they are usually different)
  • Your date of birth
  • Last four digits of your social security number
  • Name of the person who is the Primary Insured
  • The Primary’s relationship to you: parent, spouse, partner, etc
  • The Primary’s date of birth
  • Last four digits of the Primary’s social security number
  • A copy of the medical insurance card, front and back, which can be faxed or emailed to us (you can also bring your insurance card in with you to your appointment, and we will scan it for our records).

Q: What’s the difference between Medical Insurance and Routine Vision Insurance?

Answer: This one has multiple parts, so we’ll break it down.

Medical Insurance
We can bill medical insurance for examinations and treatments that have a medical diagnosis. Examples include eye infections, dry eye syndrome, and diabetes. Conversely, most Routine Vision plans will not cover these types of visits.
We can submit claims directly to BCBS PPO, Cigna PPO, Aetna PPO, United Healthcare PPO, Humana PPO, and Medicare.

Routine Vision Insurance
Routine Vision is considered one annual visit for an eye health examination and a refraction (glasses prescription). Most Medical Insurance plans do not cover Routine Vision, but it is sometimes offered as an additional benefit (carved out or subcontracted) to another company.

We can submit claims directly to VSP and EyeMed.

It is important to note that almost all medical insurance providers do not provide routine vision coverage. If you have both medical insurance and vision insurance, the medical insurance is “carved out” or subcontracted to a separate vision insurance carrier. Sometimes one medical insurer may use several different vision insurance providers depending on what plan your employer chooses. So if you are coming in for routine vision, providing only your medical insurance company’s name does not provide enough information – we need to know both.

Q: What do you mean by “verifying benefits?”

A: We do our best to contact your insurance provider(s) and find out if your coverage is active, what services are covered, if your deductible has been met, and what copays you will be charged. We are better able to estimate the charges you will be responsible for by verifying this information in advance of your appointment. Of course, we cannot guarantee coverage and may have to adjust your balance due as we receive Explanations of Benefits from your insurance company. Remember, you are responsible for all services and materials, as well as all co-pays, co-insurances or deductibles as determined by your insurance plans.

Q: What if my plan is out-of-network or I don’t have the information for my plan right now?

A: You will be responsible for paying for all services at the time they are rendered. We are more than happy to help you submit claim forms for reimbursement and/or complete any documentation you made need.