Insurance & Vision Plans

Understanding Your Coverage:

Medical Insurance vs. Vision Plans.
One of the most common questions we hear is, "Does my insurance cover this?" The answer depends on why you're being seen — and understanding the difference between your medical insurance and your vision plan can save you time, money, and frustration.

Vision Plans — For Routine Care

Vision plans like VSP and EyeMed are designed for annual routine eye exams — the checkup you schedule when your eyes feel fine and you just need an updated glasses or contact lens prescription. A routine exam includes a comprehensive refraction to determine your prescription and a general health screening of your eyes.

What vision plans typically cover:

• Annual routine eye exam
• Refraction (glasses/contact lens prescription)
• Allowance toward glasses frames and lenses
• Contact lens fitting and evaluation
• Discounts on lens upgrades (progressives, anti-reflective coating, etc.)

We also offer digital retinal photography as an optional screening during routine exams. This gives us a high-resolution view of the inside of your eye — your retina, optic nerve, and blood vessels — so we can track changes year to year. During a routine exam, retinal photos are a valuable wellness screening tool and may be an additional out-of-pocket cost not covered by your vision plan.

Medical Insurance —
For Problems, Symptoms & Conditions

If you come in with a complaint — dry eyes, floaters, redness, blurry vision, eye pain, light
sensitivity, flashes of light, a bump on your eyelid — that visit is a medical eye exam, and it's billed to your medical insurance, not your vision plan.

Medical insurance also covers ongoing monitoring and treatment of
eye conditions such as:

• Dry eye disease — evaluation, diagnostics, and treatment plans
• Diabetic eye exams — retinal screening and monitoring
• Glaucoma — pressure checks, visual fields, OCT imaging
• Macular degeneration — retinal imaging and follow-up
• Cataracts — monitoring and surgical referrals
• Eye infections or injuries — urgent and same-day care
• Floaters and flashes — retinal evaluation to rule out tears or detachment
• Styes and recurrent lid bumps — diagnosis and treatment

When retinal photography becomes medically necessary — for example, to monitor a retinal condition like diabetic retinopathy, macular degeneration, or a suspicious lesion — it is billed to your medical insurance as a diagnostic tool, not as an optional screening.

Why This Matters

Here's a common scenario: You schedule your annual routine exam using your vision plan, but during the visit you mention you've been having dry eyes and occasional floaters. Because you now have medical complaints, your doctor needs to evaluate those symptoms — and that portion of the visit is billed to your medical insurance.

Another common misconception: If you have an eye emergency — a sudden onset of flashes and floaters, an eye injury, a red painful eye — your vision plan will not cover that visit. Vision plans are strictly for annual routine care with no medical eye complaints. Urgent and medical eye care is covered by your medical insurance, and seeing your eye doctor first is almost always faster, more effective, and less expensive than the ER.

We're Here to Help
We verify your benefits before your appointment and will always let you know which insurance we're billing so there are no surprises. If you have questions about your specific coverage, give us a call at (303) 578-8055 — our team is happy to walk you through it.