It’s that time of year again when many of you are reviewing insurance plans for the year ahead. We wanted to share a quick update to help make things a little clearer as you make your decisions.
For over 30 years, our practice has stayed true to one main goal – putting our patients first. We believe in taking the time to answer your questions, explain our findings, and focus on preventive care to help you protect and preserve your vision. To keep that level of personal, thoughtful care, we’ve chosen to remain privately managed. This also means we are not contracted with every insurance plan, especially as some networks have become more limited to “in-house” providers.
A quick guide to eye care coverage
There are two main types of insurance that may apply to eye care: vision insurance and medical insurance.
● Vision insurance:
We’re in-network with Vision Service Plan (VSP). This plan covers your comprehensive eye and vision exam and provides an allowance toward glasses or contact lenses. Some VSP plans also include medical coverage for visits like red eyes, eye infections, or glaucoma follow-ups with unlimited visits throughout the year.
● Medical insurance:
We accept Medicare, UnitedHealthcare, Cigna, HealthNet, and Blue Shield. Depending on your plan, we may be considered out-of-network, which can affect your copays or coverage amounts. Medical insurance covers the medical part of your exam (eye health, disease management, etc.), but not the vision portion, the part where we determine your prescription (“Is 1 or 2 better?”) and assess your visual function. The fee for that portion is $95, and the rest is billed to your medical plan.
Affordable options if you don’t have insurance
We understand that healthcare costs are rising. For patients without insurance, we offer discounted rates (costing about $19 per month) for a full eye exam.
We also offer high-quality eyeglass lens packages starting at $149 featuring trusted Zeiss or Shamir lenses with premium non-glare hard coatings. These were carefully selected to reflect our commitment to quality, value and reliability.
Above all, we’re here to make sure your experience is warm, caring, and centered around you. Thank you for trusting us with your eye care, we truly value being part of your health journey and look forward to seeing you soon.
FREQUENTLY ASKED QUESTIONS:
1. “How can I find out if I’m in-network with your office?”
If you log in to your insurance member portal, you should be able to check using our office name or doctor please, or you may call the number on the back of your insurance card. Or contact our office, we’re happy to help check your benefits.
2. “Do you bill out-of-network insurance?”
If we’re out-of-network for your plan, we can bill your insurance for you as a courtesy or if you prefer, we could provide an itemized receipt for you to submit for possible reimbursement.
3. Do I need a referral to see you?
Since we are not contracted with any HMO plans, you may come see us without a referral.
4. What does the $95 vision portion include?
This includes your refraction (the part of the exam where we determine your glasses or starting point for a contact lens prescription), binocular vision and eye focusing assessment, the correct eyeglass prescriptions you may need such as for sport, computer work, driving, etc.
5. Are contact lenses covered in your exams?
Contact lens fittings and evaluations are not considered a part of a routine eye examination. Contact lens evaluations start at $85.
6. Why do you stay privately managed instead of joining larger networks?
Remaining independent allows us to spend more time with each patient, use the labs and materials we trust, and make decisions based on your best care, not insurance restrictions.
We know insurance can be confusing, so if you have any questions about your coverage or our fees, please don’t hesitate to reach out. We’re happy to help you understand your options.