Vision Plans and Medical Insurance Plans
We provide both medical and routine eye care and accept several insurance plans to help patients cover the costs associated with eye care. We speak “fluent insurance,” and we’re happy to answer any questions you may have to help you maximize your insurance benefits.
Please contact our office in Palmetto Bay or Coral Gables to find out if we accept your vision plan or medical insurance plan. We proudly accept the following vision plans and medical insurance plans:
Vision Plans
Medical Plans
Payment Methods Accepted
Frequently Asked Questions about Vision Plans
Vision plans offer savings on routine eye exams which include a refractive diagnosis (nearsighted, farsighted, astigmatism, etc.) and an eye health screening.
We also provide medical eye care. During your eye exam, if we discover a medical condition that requires counseling, documentation, follow-up care, monitoring, a prescription for medications, or referral to a surgeon, that would be considered medical eye care.
What does my vision plan (VSP, EyeMed, etc.) cover?
Most vision plans allow for one routine eye exam per year which includes an eyeglass or contact lens prescription, a screening for eye diseases and disorders, and a discount on eyeglasses or contact lenses. Vision plans do not cover the cost of any medical eye care.
What does my vision plan NOT cover?
Vision plans do not cover medical eye care, which includes eye floaters, dry eye, allergies, lazy eye, vision loss, red eyes, infections, and more.
What does my medical insurance cover?
If you have an eye issue or vision problem that is caused by a medical condition, then your exam is considered medical care and would be covered by your medical insurance plan.
For example, if you are having difficulty seeing with your glasses, and the doctor finds that your blurry vision is caused by cataracts, then your exam is medical care. If your eye doctor needs to prescribe medication to treat any condition, that would also be classified as medical care.
If you have a pre-existing condition or any disease that can affect vision or cause blindness (cataracts, glaucoma, dry eye, diabetes, high blood pressure, cholesterol, etc.) then your exam may be considered medical care. These services would then be covered by your major medical insurance. We are providers for many medical panels including Medicare, Medicaid, and other health plans.
Vision plans do not cover medical eye care.
How do you decide whom to bill? Can I decide beforehand?
No, the patient does not have the medical knowledge and the doctor does not know beforehand. At the time of service, we require information for both entities (vision plans and medical insurance). Once the doctor has evaluated you, the billed entity is determined by the final diagnosis and treatment plan (what you have and what we are going to do).
Why is this so complicated?
We must follow rules that are set by our contract with your insurance company.
Can I use my vision plan and medical insurance the same day?
Even if your eye exam is billed to your medical insurance, you may still use your vision plan benefits to purchase eyeglasses or contact lenses that same day or on a later date.
Additional questions?
We are happy to answer any questions that you may have about your insurance coverage. You may also want to consult with your insurance company, vision plan, or human resources department. Be mindful that until the doctor evaluates you, there is no way of absolutely determining which coverage is applicable.