Medical vs Vision Insurance

Okay, let's move into discussing the difference between medical insurance versus routine or vision insurance. First of all, your medical insurance would be like your Blue Cross and Blue Shield, your Medicare, your Cigna, your United. Basically, it's when a patient has a medical diagnosis such as Cataract, or Glaucoma or AMD and we’re able to bill for a medical reason. Okay, now side note here, that your Optometrist is considered a specialist, so that will help you when you're determining your co-pays and doing your vision eligibility benefits. 

So, moving on to the vision insurance, this would be like your VSP or your EyeMed. And this is when a patient comes in for a comprehensive routine refractive vision eye exam and they have a diagnosis that is Myopia, Presbyopia, Astigmatism, Hyperopia and we bill their VSP or their EyeMed for their comprehensive, routine, as patients often call it, eye exam. As well as, we're able to bill their glasses or contacts. So, why is it important to understand the differences? 

What we bill is determined by the situation. What does the doctor find, is it really, truly a comprehensive eye exam or routine eye exam that should be billed to VSP or EyeMed, for example. Or do they have a medical condition, such as Diabetic Retinopathy and it needs to be billed to their medical insurance. So, very important that we understand the differences and why is that important to you? A lot of times, again, we'll see because we haven't taken the time to research to understand or we hasten through the billing process, you might see a routine comprehensive eye exam accidentally billed to the medical insurance and that often has to do with taking the time up front, at front desk when we’re scheduling and indicating what they came in for etcetera. But what happens when we bill the wrong insurance? Should have gone to their vision insurance and we sent it to their medical. Well, the claim gets denied because most insurances you'll find do not cover a comprehensive eye exam, in the sense of a routine eye exam. Okay, some do, but a lot don’t and they need to go to their vision insurance, such as VSP, EyeMed, etcetera. But what happens that claim gets denied, not only do we receive an explanation of benefits saying that the claim was denied, but the patient does as well. Stating we didn’t pay this and now you owe it. What happens then, they're not happy with you first and foremost as a practice, and the insurance company to be realistic, but really it comes back on us and it creates more work, they're upset, and that's not a good situation to have, because we want to retain our patients. It is easier to retain a patient than it is to get a new one. So, let's make sure that we understand the difference and that we take the time to bill appropriately from the very start.