Vision vs. Medical Insurance
What's the Difference?
Vision Insurance covers a Routine Well-Eye Examination that includes a screening for eye disease and the cost of determining your prescription by Eye Refraction for astigmatism, nearsightedness or farsightedness. Eye Refraction is the measurement of a glasses prescription and the determination of appropriateness of glasses or contact lens wear.
If you wish to receive a glasses or contact lens prescription at your next visit, you should notify the appointment scheduler that you would like to book a Routine Well-Eye Exam.
We will expect to bill your vision insurance. Some patients may have specific vision insurance to cover all or a part of this type of visit, different from their medical insurance. Your vision plan may also provide a vision hardware benefit for frames, lenses or contacts.
As part of the Routine Eye Exam, your eye doctor also screens for certain medical
conditions and diseases, including:
Hypertensive Eye Diseases
Retinal Holes & Tears
If your routine well-eye exam exposes a medical condition
related to your eye, your medical insurance can be used.
(Please note: This cannot be determined prior to a scheduled appointment, as it is based on what the doctor diagnoses during your routine well-eye exam.)
The difference between vision insurance and medical insurance is one of the most common misconceptions to patients
A Medical Eye Exam or an Office appointment for a medically-related eye issue is typically covered by medical insurance. Should the doctor diagnose an eye-related disease or condition during your Routine Well-Eye Exam, then it would be possible to bill your medical insurance instead of vision insurance (subject to deductible, copay, etc for your medical insurance plan). Additionally, it is likely that another medical office appointment would then need to be scheduled for you to return for additional diagnostic medical testing, follow-up management, and treatment for your diagnosed eye related medical condition or disease.
Medical Insurance covers eye-related medical conditions and diseases, such as:
Retinal Holes & Tears
Optic Nerve Disorders
Hypertensive Eye Issues
If the purpose for your appointment is for a diagnosed eye related medical condition or disease, then notify the appointment scheduler you need a medical eye exam/office visit and we will expect to bill your medical insurance.
PCP Referrals: If your medical insurance requires a referral please contact your Primary Care Physician/PCP to ensure one is sent to us before your appointment. We can attempt to initiate the PCP referral request on your behalf, but typically, your PCP will require your approval.
Not Sure What Your Insurance Covers? Let Us Help
Our office is very knowledgeable about certain insurance plans we can or cannot bill. However, there are hundreds of insurance companies and various plans. If you have both vision and medical insurance, they are frequently through two separate insurance companies. Your ID card may provide that information.
As an additional courtesy provided to all of our patients, we would be happy to contact your insurance on your behalf to verify coverage and receive an estimate of eligible benefits. Just give our office a call (425)747-2020 or email us at and provide us with the necessary information from your current insurance ID card. We are happy to assist you in verifying insurance coverage and obtaining access to the eye care you deserve!