Vision Plan vs Medical Insurance: What Every Optometrist Needs to Know

In order to provide the best care possible, it is important for optometrists to have a clear understanding of their billing options. This includes knowing when and how to use medical insurance and vision plans appropriately. The right strategy can ensure that both medical and vision plans are used to the patient’s and optometry practitioner’s best advantage.


Differentiating between and understanding vision plans and medical insurance can be a little confusing for practices, thereby affecting their optometry billing operations. To make things easy, let’s assess the key distinguishing factors of the plans, when they can be used, and how you can make handling them a seamless process.



Distinguishing Factors Between Vision Plans and Medical Insurance


The primary distinction between each medical insurance and vision plan is coverage. Medical insurance covers more than vision plans, but the latter can be invaluable for people who wear glasses or need eye exams to maintain a healthy lifestyle and keep their eyes in good shape.


Vision plans can cover routine practices such as regular eye checkups and refractions. Basically, anything that’s not medically necessary will be covered under the vision plans. Vision insurance plans can also be useful in covering your glasses, frames, as well as prescription contact lenses.


On the other hand, medical insurance is applicable when there is a medical sign, symptom or condition that demands medical attention. However, it does not cover cases where myopia, hyperopia, astigmatism, or presbyopia are the reason why the examination is being conducted.



How Frequently Can Vision Plan and Medical Insurance Coverage be Used?


Most vision insurance plans permit the use of coverage only one time per year. Patients can get an on-the-spot consultation and a prescription for glasses or contacts under this plan. The catch is that these services need to be performed on the same day as vision insurance cannot be separated into examination and refraction. Hence if an eye examination is performed, it is essential to carry out refraction as well on the same day to get the benefits of the visual plan coverage.


Medical insurance, however, can be used multiple times in a year. The only condition is that medical insurance can be used in case of a medical necessity. A great way to determine this necessity is by understanding the objective of the treatment. If the patient is treating his/her eyesight and not purchasing eyewear to correct their vision, then it will come under the medical insurance coverage.



Implementing a Strategy that Benefits Both - Patients and Optometrists


It is important for optometry practices to always make clever use of the benefits offered by both vision and medical insurance plans. This not only benefits patients but also helps practices to be fairly reimbursed for their services. Suppose a patient visits your practice showing a symptom that necessitates medical treatment. What do you use? Vision plan or medical insurance coverage?


The best approach to coordinate the patient’s insurance coverage in the above-mentioned scenario is - Use the medical insurance coverage for the initial appointment as there is a medical necessity for the examination. This way, the patient can use the vision insurance with its covered refraction in the future. This approach minimizes the patient’s out-of-pocket expenses and boosts their confidence in your practice.



Are you struggling to cleverly coordinate medical insurance and vision plans? The seasoned optometry billing professionals at CS Eye can help you deal with the complexities of vision and medical insurance coverage easily. Get in touch with us to know more about our optometry billing services.


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