What is the Difference Between Vision and Medical Insurance?

What is the Difference Between Vision and Medical InsuranceEye care can be unique in that most eye doctors accept vision and medical insurance. Sometimes it can be confusing for our patients to understand the difference. Hopefully, the following information will be useful in helping you understand the difference.

Vision insurance is designed to pay toward “routine” comprehensive vision examinations.  Vision insurance is not designed to cover medical eye issues such as red eyes, monitoring for diabetes, or glaucoma testing. 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. Vision insurance plans may pay toward the fitting of contact lenses. Vision insurance usually contributes toward the purchases of glasses and 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, eyelid styes, dry eyes, glaucoma treatment, and loss of vision caused by a medical condition of the eye.

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 may need to submit the examination to the medical, not vision, insurance. Believe it 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 diagnoses. Medical insurance plans will deny this portion of the examination. If we are filing the examination to your medical insurance, there will be an out-of-pocket fee to determine the glasses prescription.

If we determine during your routine examination that there is a medical eye problem, we may need to schedule you to return to the office for a follow-up examination. The insurance companies prefer that we not file vision and medical insurance on the same day.

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Eyes On Henry

Call Us: (864) 585-0208

Visit Us: 399 E Henry St
Spartanburg, SC 29302

Office Hours

Monday: 7:00am – 12:00pm & 1:00pm – 5:30pm
Tuesday: 8:00 am – 5:30 pm
Wednesday: 8:00 am – 5:30 pm
Thursday: 8:00 am – 5:30 pm
Friday: By Special Appointment
Saturday & Sunday: Closed

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