Vision Benefits Plan

Today’s health care environment has become more confusing and complex.

Understanding your health insurance and vision benefits is not as easy as it once was. The following information may help clarify many misconceptions about your health and vision insurance.

Many common vision insurance programs only cover the vision portion of the overall eye health examination. There are two distinct and important elements to every visit. First, the most important aspect of your visit is to insure quality of life by providing you with a comprehensive, thorough medical examination of your visual system. Many eye diseases that affect your vision have little or no symptoms until the problem has become sight-threatening. Routine eye health examinations are critical to prevent debilitating eye disease. Secondly, each comprehensive medical eye exam will include a vision component to analyze and prescribe, if necessary, eyewear or contact lenses to correct your vision.

It is important for you as a patient to fully understand your insurance coverage. At the time of service, you are required to pay any co-pay and/or deductible. It may be necessary for the doctor to perform additional testing while in our office. Some of this testing may not be covered by your vision benefits, but may qualify for payment by your medical plan. If the testing will not be covered, it will be your responsibility for payment.

The following is a summary of a few vision insurance programs. Hopefully, this information will be helpful to you in choosing proper eyewear, contact lenses and eye care for you and your family. For more detailed information, please refer to your insurance policy or benefits coordinator.
VSP (Vision Service Plan)

In most cases, VSP will cover your eye health and vision exam. In some cases there may be a co-pay and/or deductible, which is the patient’s responsibility. The co-pay must be paid at the time of service. Vision Service Plan covers a portion of your eyewear purchase. Each specific Vision Service Plan pays towards your eyewear purchase at different levels. Please refer to your insurance handbook for your benefits. If our Insurance Benefit Coordinator, Maggie, could be of assistance, please feel free to call her. The Vision Service Plan is not an entitlement plan and you can choose any frame or lens option recommended by the doctor. Our optical staff will be happy to determine if you are responsible for any out-of-pocket expenses.

MEDICARE

Conner-Smith Eye Center fully participates in the Medicare program. We accept assignment of benefits on behalf of each eligible patient. The eye health examination may be a covered service under the Medicare program. However, as mandated by Federal law, the refraction portion of the exam is a non-covered service. A refraction is the part of the exam where your best corrected vision is established. Each Medicare patient will be charged $28 for the refraction. This charge must be paid at the time of service. Medicare does not offer any coverage towards eyewear, unless it is the first pair of glasses you receive after cataract surgery. The purchase of eyewear is the responsibility of each Medicare patient.

Other Vision Insurance Plans that we participate in include:

  • Hoosier Healthwise (Medicaid)
  • EyeMed
  • Vision Advantage
  • Vision Care Plan
  • Superior Vision
  • Anthem Plans (excludes HMO Plans)
  • MECA
  • SIHO
  • VSP (Vision Service Plan)

There are several other Vision Plans for which we are providers. If we are not a provider of your particular vision plan, we ask for payment at the time of service and we will be happy to help you file your claim so that you may be reimbursed directly by your insurance company.

Due to the large number of different Vision Insurance Plans, it is impossible to know the specific details and reimbursement policies of each. It ultimately is your responsibility to know what type of coverage your plan offers. Our Insurance Benefits Coordinator is here to help you with any questions you may have.

Medical Insurance Plans that we participate in include:

  • Hoosier Healthwise (Medicaid)
  • Medicare
  • SIHO
  • Anthem Plans (excludes HMO Plans)
  • Sagamore
  • IHN
  • Encore
  • Humana Choice Care