Published: 20 April 2021

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 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 during 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 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.

Published: 07 April 2021

Nowdays, many people prefer shopping online to shopping in stores for many of their needs. With technology constantly improving and evolving, people like the convenience of shopping online. Whether it’s clothing, electronics, or even food, you can easily find almost everything you need on the Internet. Eyeglasses, unfortunately, are no different. Many online shops have been popping up in recent years, offering people that same convenience. But what they don’t tell you is that it comes at a price, and this article’s purpose is to shine a light on the negatives of shopping online for eyeglasses. Here are some important reasons to avoid the temptation of ordering glasses online. Accuracy- Instead of saving the most important point for last, we will focus on the main reason that ordering eyeglass online is not the best choice. Product accuracy is a huge reason that the online market has not completely taken off. Every person who needs eyeglasses needs to understand the process for how their prescription is obtained in order to truly understand why shopping online is not ideal. It is called an eyeglass prescription for a reason. Your ophthalmologist or optometrist is prescribing your lenses as if they were prescribing any form of medication. To take that prescription and hand it over to a website that does not require licensed workers to interpret the prescription is not the wisest choice. Equally as important as the prescription itself are the pupillary distance (PD) and the optical centers measurements. These measurements are not given at the time of the examination by the ophthalmologist or optometrist, but instead are administered by the optician at the point of sale. Not having these measurements done accurately will negatively affect the quality of vision as much as an error in the prescription. Quality- The quality of the product you are purchasing is often affected when making the decision to purchase online. The saying “too good to be true” is the case more times than qualified optician. Websites rely on mass production in order to operate. Factory workers operating machines pale in comparison to the experience you will receive in a professional office. Skilled opticians who interpret and manufacture your eyeglass prescriptions are held to a much higher standard than factory workers. Warranty- Due to their low prices, most of these websites do not include any form of product warranty or guarantee. Local eyecare practices, however, stand behind your purchase. If there are issues with adjustment or a patient not being comfortable in a specific lens or product, professional optometrists and opticians are willing to work with you. This personal experience is not attainable on the web. Coordination with Your Doctor- With the complexity of eyeglass lenses, the ease of working in house is always a benefit worth keeping in mind. Eyeglass lenses can be very complex products. Having the benefit of being able to work directly with the doctor gives the optician the best chance to put you in the exact lenses you need. There is a substantial difference in the percentage of error between shopping online and the care you get in a private practice. Personal Experience- The biggest factor for many people is that the personal experience you get when shopping in person is something you cannot obtain by using the Internet. Dealing with the same opticians year in and out is something patients emphasize and appreciate. Just like people tend to keep the same doctors over the years, patients like knowing that the same people will be in charge of making/ordering their glasses. Shopping online will not offer that experience. All of these factors should be carefully weighed when making the decision to shop online. While the initial price difference could entice you at first, know that it does come at a price. Whether it be a warranty, quality, or convenience issue, all of these are very important factors when buying glasses. People sometimes tend to discount how intricate eyeglasses are. Purchasing eyeglasses is handled best in person by professionals who can provide you with the utmost care and quality. Article contributed by Richard Striffolino Jr.