Published: 26 May 2025

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.

Published: 26 May 2025

There is a common misconception that any adverse reaction to a drug is an allergy. That is definitely not the case. Reporting to your doctors that you have an allergy to a medication when what you really had was a side effect could potentially create a substantial alteration to your medical care in the future. And this could mean a physician might avoid using a drug that could possibly save your life because of the fear of an allergic reaction. An anaphylactic allergic reaction generally produces a very specific set of symptoms, including difficulty breathing due to constriction of windpipe, swelling of your tongue, and/or a rash and hives that break out over your body. While an allergic reaction can present in other ways, these are the most frequent reactions that occur when you have a true allergy to something. If that is not the type of reaction you had then it probably isn’t an allergy. If you are uncertain if your reaction to a medication is an allergy or not, testing by an allergist may be able to tell you if your reaction was a true allergy or a side effect. It is not always just the patient who can misdiagnose a side effect as an allergy. Sometimes it is the doctor or the dentist who tells the patient, “You must be allergic.” This is a quick and easy explanation, but it is not always the correct one. In optimal medicine, there are not always a lot of “lifesaving” incidences, but there are several drugs that are the preferred treatment for certain conditions and if you report an allergy to these drugs it may make your doctor use a much less effective drug. Here are some specific examples of when a false report of an allergy may lead to less effective treatment or even failure to offer life-saving treatment. Epinephrine The most common potential “lifesaving” drug for which patients report an allergy to is Epinephrine. The story usually goes something like this: “I was having a dental procedure and soon after the dentist injected my mouth with a local anesthetic of lidocaine with epinephrine my heart started racing and pounding out of my chest and I almost passed out.” This hypothetical patient may come to the conclusion--or the dentist may mention--that the patient is allergic to epinephrine. That reaction is almost never an allergy but a side effect that occurs when a substantial dose of the lidocaine and the epinephrine gets into the blood stream and stimulates the heart. The mouth and gums are very vascular, and it is easy to have some of that injection end up in the bloodstream, but that reaction is not an allergy and should not be reported as such. Epinephrine is used to treat severe (anaphylactic) allergic reactions and not using it if you were to ever have a severe allergic reaction could lead to some very bad outcomes. This is not to say you can’t be allergic to epinephrine. You can, but it is extremely rare. If there is any doubt you should be tested by an allergist before you ever record yourself in a medical setting as being “allergic” to epinephrine. Cortisone/Steroids Cortisone is a highly effective drug to treat many conditions. Again, it is unlikely but not impossible to be allergic to it. We all have naturally occurring cortisol circulating in our bodies and cortisone is a very similar molecule but not exactly the same. Cortisone also can have a wide range of side effects depending on where and how it is administered Some of the common side effects of cortisone, which have been mislabeled as an allergy, are: increased blood sugar, insomnia, mood swings, nausea, and weight gain. These are all known side effects of the drug and not allergies. Cortisone side effects are associated with only certain routes of administration and are often dose dependent. Why is this important in terms of your eye care? We often use cortisone derivatives, like Prednisolone, to fight inflammation that may occur in your eye, particularly after any ocular surgery. If you report that you are allergic to cortisone when you really only experienced a side effect, we are going to have to use a less-effective medication to deal with your eye inflammation. As I mentioned above, most side effects are dose dependent and the dose you got in a pill may have caused a side effect you’d rather not have again but the dose in an eye drop is significantly less and highly unlikely to give you the side effect you got with a pill taken orally. Antibiotics People often report they are allergic to antibiotics when they really experienced a side effect. The most common side effect with oral antibiotics is some type of gastrointestinal disturbance, like nausea, or diarrhea. If that was what you had and just prefer not to get that again you still shouldn’t report it as an allergy. If you do, then the drug can’t be used as an eye drop or ointment that might be the best treatment for your condition. An antibiotic eye drop/ointment is very unlikely to produce the same gastrointestinal trouble that the same antibiotic gave you when given as a pill. You don’t want to take away the most effective treatment for your problem because you mislabeled a side effect as an allergy. Sedatives/Anesthesia With sedatives and anesthesia, the issue is often how a person felt either during or after a procedure. Common comments are “it took me too long to wake up” (side effect not an allergy); “the sedative I got in my IV burned when it went in” (side effect not an allergy); “I was sleepy all day” (side effect not an allergy); “I was nauseous after the procedure” (could be an allergy, but much more likely to be a side effect). Why are these important? We can make you much more comfortable for a local anesthesia procedure if we can use some sedation. Using sedation may be better for you and the doctor performing the surgery because you are much less likely to move during the surgery if you are resting comfortably. If you ever have an untoward reaction to a medication it is worth your time and effort to really probe into the issue to figure out if what you had was really an allergy or just a side effect. Your life may depend on it. Article contributed by Dr. Brian Wnorowski, M.D.