Q: What is the difference between medical and vision insurance?
A: Medical insurance applies to office visits that are evaluating or treating medical diagnoses such as cataracts, glaucoma or macular degeneration. It generally does not cover routine vision needs such as measurements for eyeglasses (refraction) or contact lens fittings.
Routine vision benefits generally cover a baseline eye health exam and the measurements for eyeglasses in addition to materials such as eyeglasses or contact lenses. These benefits do not cover comprehensive medical evaluations or testing related to medical diagnoses.
Q: Why won’t my medical insurance cover my refraction charge?
A: The measurement for eyeglasses (refraction) is usually not covered by medical insurances because it is considered a routine vision benefit and is not related to the treatment of a medical diagnosis. Most medical insurances consider this an out-of-pocket expense for the patient, unless they have routine vision benefits. Make sure you understand your insurance plan and how it covers refractions before your appointment.
Q: Why did my diagnostic testing not fall under my exam copay since it was part of the medical exam?
A: Although diagnostic testing is often performed at the same visit as an exam, it is considered by medical insurances to be a separate benefit from the medical exam and may be subject to deductible or percentage copay, depending on a plan. Make sure you understand your insurance plan and how it covers testing before your appointment.
Q: Why did my secondary insurance not cover my balance?
A: Secondary insurances are often subject to their own deductibles or percentage copay before they will cover any services. Make sure you understand how your secondary insurance applies benefits before your appointment.
Q: Why am I paying specialist copay rather than a PCP copay?
A: Medical insurances consider ophthalmologists and optometrists to be specialty providers since they do not provide primary care, but focus only on eye care.
Q: Why is my out-of-pocket expense different than originally quoted?
A: Hometown Vision Care’s verification of insurance benefits is only an estimate of possible out-of pocket expenses. Insurance companies do not guarantee payment when quoting benefits, so our information is simply an estimate, not an exact amount that will be due after services are rendered.
