Questions Regarding Your Insurance?
If you have questions regarding your insurance benefits, we recommend that you contact your insurance company and/or your benefits administrator. This is your best resource for accurate information.
Insurance Benefits Vary Greatly Between Plans
Your insurance plan may not cover all services provided or it may pay only a portion of the fees for covered services. Insurance companies determine what is covered (or not) and how much they pay for such services. This results in great differences in benefits provided by various insurance plans and is determined by the insurance companies and/or your employer. In most cases, insurance companies do not pay your doctor’s customary fees; therefore the doctor accepts a discounted fee in order to belong to these plans.
Routine Vision vs. Medical Eye Visits
Routine eye examinations are included in most “vision care” plans. Deductibles or co-payments may apply. Routine (vision care) exams are typically covered every 12 to 24 months. Medical eye care is typically covered by your medical insurance, this insurance being totally separate from your vision care plan. Vision care plans do not cover medical eye visits and visa-versa. Strict rules apply regarding which services are medical in nature vs. vision care, especially regarding insurance billing and coverage. Vision care typically involves services ranging from routine examinations to tests needed to determine prescriptions for eyeglasses and contact lenses. Medical eye care involves the treatment of conditions such as eye injuries, infections and eye diseases.
Medicare and Eye Care Services
Medicare pays for medical eye care and not vision care. In a routine eye examination, Medicare will only cover services that are necessary and also have a medical diagnosis. Medicare never pays for the tests needed to determine eyeglass and contact lens prescriptions.
Your plan may have a list of preferred providers. We participate in most major insurance plans. If our doctors are not on that list, then you can still be seen at Roosevelt Vision yet your insurance reimbursement may be less than it would be if you went to a preferred provider. You will need to pay for the services provided and get reimbursed by your insurance company. In some cases is more prudent to take advantage of our “time of service discount” available to any patient who pays for our services in full on the day the services are provided. In either case, we can provide you with the documentation you will need to submit a claim to your insurance company.