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The eye care medical field has an unusual split between two different types of insurance for covering eye issues: health insurance and vision insurance. Not all patients have both.
In most cases, your health insurance is used to cover medical and surgical eye problems but not routine exams or the cost of contacts or glasses. Those things are often covered by separate vision insurance.
Why the difference? Originally, health insurance was created to take care of health “problems” and wasn’t designed to cover “routine,” “screening,” or “wellness” exams.
Since health insurance wasn’t going to cover “routine” eye exams, the vision insurance industry arose to help insure/cover those routine exams as well as the costs of glasses and/or contacts if they were needed.
That dichotomy now often causes great confusion when you make an appointment at your eye doctor. When making your appointment, the office is going to need to know which insurance, if you have both, you are going to be using for this particular visit.
Why does the office need to know in advance which insurance you are using?
The main reason is that the rules and sometimes the providers are different for each insurance plan. The vision plans often require the office to check on your availability for coverage and get pre-authorization for the visit BEFORE you get to the office. There are also differences in which providers within an office are in network for the insurance. For example, in some practices the optometrists might be in all the vision plans but the ophthalmologists might not participate in those plans. If you make an appointment with one of the ophthalmologists and tell the office you are using your health insurance, you can’t change your mind the day of the appointment and use your vision insurance instead.
There are also differences in what the insurance will cover as a reason for the exam. Vision insurance typically covers ONLY routine exams. Those are exams for which you are coming in specifically to get your vision, glasses and/or contact lens prescription checked and get an overall eye health screening. That means you CAN’T have a medical complaint about your eyes that you want the doctor to deal with. Eyes itchy? Need to use your medical/health insurance. Dry eyes? Need to use your medical/health insurance. Have a cataract? Glaucoma? Macular Degeneration? Need to use your medical/health insurance.
Why not just use your medical insurance all the time? That’s mostly because if you have no complaint at all your medical insurance won’t cover that visit (and “my vision is a little blurry” usually won’t cut it). There is one other issue and that is the refraction.
A refraction is when we check to see if you need a new eyeglass or contact lens prescription. For the most part, health insurance won’t cover the fee for the refraction, which is a procedure that is separate from your eye health exam. Your vision insurance will cover the refraction but not the exam if you are having a medical problem.
Here’s the real kicker. Your health insurance will cover your medical eye problems and your vision insurance will cover your refraction, BUT you can’t use both insurances at the same visit. It has to be one or the other. (Ridiculous right? I didn’t make the rules, just trying to abide by them.)
So, what are your choices if you have both a vision plan and health insurance? If you have a problem, you need to use your health insurance. If you want to have your eyes refracted so you can get new glasses at the same time you can either pay out of pocket for the refraction OR you can come back in for a second visit, using your vision plan to get a refraction and eye health screening exam so that the refraction gets covered. (Again - I didn’t invent these rules--I am just trying to help you navigate them.) If you don’t want to make two visits, then use your health insurance (with the appropriate complaint) and pay for the refraction and just use your vision insurance to help pay for the actual contacts or glasses you are going to buy.
If you have a question, it’s best to ask when you call the office to inquire about an appointment.
Article contributed by Dr. Brian Wnorowski, M.D.
This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.
Motherhood...the sheer sound of it brings enduring memories. A mother’s touch, her voice, her cooking, and the smile of approval in her eyes. Science has proven that there is a transference of emotion and programming from birth and infancy between a mother and her child--a type of communication, if you will, that occurs when the infant looks into its mother’s eyes. So what is this programming? How does it work and what effect does it have on the life of the child? What happens if it never happened to the infant? What happens if the mother is blind?
The gaze into a mother’s eyes brings security and well being to the child. When she gazes at another person, it makes the infant look at what she is gazing at, and introduces the infant to others in the world. This is known as a triadic exchange. So now the baby's world is no longer just one person--its mother--but also includes third parties, thereby increasing social skills and interaction.
Interestingly, if a mother is blind, it does not adversely affect the child’s development. A study published in the Proceedings of the Royal Society B showed no deficit in the baby's advancement. The sheer fact that the infant looks into the mother’s eyes helps with connectedness and emotional grounding.
Looking into mom’s eyes and face teaches facial recognition and expressions of emotions and is primarily how the child learns in the first few months of life. Additionally, infants tend to show a preference to viewing faces with open eyes rather than closed eyes, thus stressing the importance of the mother or caregiver’s gaze.
Some health benefits to gazing into the mother’s eyes is a lower incidence of autism, or spectrum disorders, and better social skills, higher learning capacity, and emotional groundedness.
The beauty of a mother’s gaze is that the child can feel the emotions of love, security, safety, and overall well-being by connecting with her through eye-to-eye contact. This sets the stage for the future development of social skills, visual recognition of people, and readiness for social interaction in the world.
A big thank you to science and mothers for proving what we already know--that the values in life can be taught to a child “through a mother's eyes,” setting the course for proper interaction for life skills and relationships.
References:
1. Kate Yandell, Proceedings of the Royal Society B ,04/10/2013.
2. Maxson J.McDowell, Biological Theory, MIT Press, 05/04/2011.
This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.
