Understanding Your Eye Care Coverage

We know navigating insurance can be confusing! At Visionary Realm Optometry, we work hard to help you maximize your benefits. The most important thing to know is that your eye health needs are typically covered by one of two types of plans: Medical Insurance or Vision Plans.

Here is a simple breakdown of the difference:

1. Medical Insurance

(e.g., Aetna, Blue Cross Blue Shield, United Healthcare)

What it Covers:

Medical Insurance is used to treat, diagnose, and manage specific diseases, symptoms, or injuries of the eye.

Examples of Medical Eye Conditions:
- Diabetes-related eye exams (Diabetic Retinopathy)
- Cataracts
- Glaucoma
- Macular Degeneration
- Dry Eye Syndrome
- Eye infections (pink eye), allergies, or injuries
- Sudden vision changes or flashes and floaters

When to Use It:

If your visit is focused on a specific health problem or symptom, we will bill your medical insurance. This is similar to how you would visit your primary care physician or a specialist (like a cardiologist). Co-pays, deductibles, and co-insurance apply just as they would for any other specialist visit.

2. Vision Plans

(e.g., VSP, EyeMed, Spectera)

What it Covers:

Vision plans are wellness and discount plans primarily designed to cover routine care and financial assistance toward eyewear.

Examples of Vision Coverage:
- Routine annual eye exams (when you have no specific medical complaints or symptoms).
- Discounts or allowances for glasses frames, lenses, and lens options.
- Discounts or allowances for contact lenses.

When to Use It:

If your visit is a standard annual check-up to determine your current prescription and confirm your eyes are healthy, we will bill your vision plan. Vision plans usually cover one routine exam per year.

*Sometimes, you may start with a routine check-up, but the doctor discovers a medical condition (like glaucoma or a serious dry eye condition). In these cases, a secondary or follow-up visit may be scheduled to complete any additional testing or treatment needed.

Our In-Network Plans

We are in-network with the following major Medical and Vision plans. If you do not see your specific plan listed, please call or text our office at 405-458-9393 to verify.