Know your carrier and the information about the primary policy holder for vision. Usually your card will say the medical and maybe the dental information directly on the card, but frequently the vision insurance is not listed. The vision insurance is usually subcontracted out through the medical insurance. In order to check eligibility, review benefits, and authorize use you must be able to tell the office of your choice some information about the policy holder: typically date of birth, spelling of their last name, and the last four digits of their social security number. It really expedites things if you know the vision plan by name: Vision Service Plan, Vision Care Plan, Superior Vision, Opticare, Eyemed, Avesis… If your office of choice does not appear in the network, call and ask about out of network benefits and self-submission of claims for personal reimbursement.
Understand the difference in use of medical versus vision insurance for your eyes. Vision insurance is great for wellness exams and purchase of glasses and/or contacts. If you are not well, AKA: you have a medical indication for dilation, you suffer from a chronic eye condition, or you’ve been told to visit an eye doctor by any healthcare professional for any reason other than blurry vision — you should use medical insurance for that visit because the testing is medical in nature! In addition to a visit, vision change can be demonstrated upon request and the refraction performed to provide the best level of care, but this is optional. Your eye doctor is a specialist in eye care, but you’ll want to go somewhere that the office is approved to accept your medical insurance. That is why 4Sight iCare is approved to see PPO insurance holders of United Healthcare, Medicare, Humana, Blue Cross Blue Shield, and we are constantly adding more. IF you have very stable vision and don’t need correction but do have a medical indication for a comprehensive eye exam at least once a year, our advise is to drop the vision plan. Why pay for something that has benefits for wellness exams and materials you won’t be using. IF your vision changes and you feel you may need glasses, then re-up the vision plan and ask for a refraction at your next exam.
STOP getting CHEAP eye exams offered without insurance less than $65 when your copay is valid at places that perform exams worth twice that! This is baffling! We don’t believe the public perception is clear that the P in HIPAA stands for Portability. If you don’t find something you like at the office or the eyeglasses are just too expensive, buy your glasses at the place offering 2 for $99. The product may be inferior, but if it helps you see and it’s within budget then do what makes you comfortable. BUT DO NOT cheapen out on the exam when the copay is the copay is the copay. If you have insurance with a listed copay for an exam why would you cheapen that value by getting a cheap exam? WHY!?! Yet everyday people walk into a place advertising a cheap exam with the purchase of glasses and use their high quality insurance on an exam not worth the time spent there. The federal reimbursement for examinations with medicare is the standard by which all medical insurance companies base their payment for the service of a quality eye exam. This is currently over $125, and frankly you get what you pay for; well, that is, except if you have good insurance and you waste it on an exam that is offered to someone with no insurance at the same rate or sometimes less than your copay. DON’T KEEP WASTING YOUR MONEY — drop the insurance or use it to get a quality exam.
When using insurance at an office, go over the plan with them prior to the service. 4Sight iCare reviews each part of your insurance with you the day of your visit. We authorize all services that are expected the day of your visit so you can know exactly what your portion of the bill might look like before you purchase. This free consultation is something we ask our patients to arrive 10 minutes prior to their exam in order to get the most out of their benefits. We will break it down and explain your individual plan’s benefits so you know which parts are covered in full, covered with an additional copay, or not covered by your insurance.