Understanding health insurance can be very tricky and Elite Eye Care would like to help you navigate this topic. Essentially when you see your Optometrist, “eye doctor”, they may ask you for both types of insurance, vision and medical. You may think, “why is my eye doctor asking for medical insurance?” But the reason for your visit will dictate which insurance you can use and which insurance your provider can bill to get reimbursement. Let’s break down the different types of insurance and instances when you would use each.

Medical Insurance:
This is the same insurance you use when you go to the walk-in clinic or have a procedure at your primary care providers appointment. It is also used at your Optometrist’s office when you have a medical problem or condition, for example when you have pink eye or something in your eye. This insurance is also used when a patient is a diabetic and is requesting a diabetic eye examination. It is a good idea to have this insurance on file with your Optometrist so that if something were to happen, like an eye injury, when you arrive the insurance is already on file with your more frequently used vision insurance.

Vision Insurance:
Your vision insurance provides benefits for a wellness eye examination, frames/eyeglass lenses, and contact lenses. This insurance is used when you want to update glasses or your vision seems to be getting blurry. Each plan and vision program has very different benefit options that range in amount and frequency of coverage. It is a good idea to contact your vision insurance company so that you understand your benefits. You may be paying monthly premiums and not taking advantage of your full benefits.

Here are some tips/tricks to understanding your coverage:

  • Check your vision insurance or call your Optometrist (Elite Eye Care) to figure out your coverage. You should take advantage of your yearly wellness check and eyewear benefits if you are paying monthly premiums.
  • Vision insurance does not provide any benefits for an eye injury or medically directed exam.
  • Check your coverage or talk with your Optometrist (Elite Eye Care) to maximize your insurance benefits- for example: Should you use your benefits towards eyeglasses or contact lenses? It may be more beneficial to use your benefits for one and pay out of pocket for the other.
  • Some vision insurances also provide discounts on non-prescription sunglasses or multiple eyewear purchases.
  • Use It or Lose It- your benefits are available for a certain length of time and if you don’t use them within that period they may not be available.
  • Just ask questions: We understand that insurance is difficult to understand and at Elite Eye Care we will do our best to help you understand and maximize your benefits.

I hope that this has provided you with some better understanding of your insurance benefits. It is always best to understand your coverage before visiting your provider so that you and your provider can maximize your options and benefits. Please feel free to call (701-390-1315) or email (eliteeyesnd@gmail.com) our office with any questions.

-Dr. Keller