There is a lot of confusion out there on how medical and vision insurances work. Over my 22 years in practice I have explained the differences countless times. I have decided to write a blog on the subject in hopes of providing some clarification.
Optometry is one of the only professions that accepts dual insurances. Years ago, before the profession of Optometry expanded to include medical diagnosis and treatments, vision care plans were created. Vision Care Plans (VCP) offer routine vision examinations for healthy eyes that include a refraction and benefits towards products like eyeglasses and contact lenses. As the profession expanded, Optometrists evolved into Optometric Physicians. We were now educated and credentialed to perform ocular health assessments and treat eye diseases such as conjunctivitis, glaucoma and ocular surface disease. The examinations became longer and more extensive but the reimbursement from VCP remained the same. Policy changes were proposed and passed that gave Optometric Physicians the right to be included as providers on medical insurance plans.
Think of an Optometrist as the Primary Care Physician for your eyes. We have the tools and education to detect the problem and treat if within our scope of practice. If outside our scope of practice we refer to the appropriate Ophthalmologist (Surgeon) for further evaluation and treatment. Within Optometry, we have doctors that specialize in low vision, ocular disease and neuro-optometric vision rehabilitation. Within Ophthalmology, we have doctors that specialize in Cornea/Cataract, Glaucoma, Retina and Neuro-Ophthalmology. So which doctor should you visit? This is where your local Optometrist can help channel you to the right doctor.
The Optometrist determines which plan to submit the claim to by what the patient’s primary reason for the visit is. Billing a VCP is appropriate if the patient is looking for new glasses/contact lenses or experiencing a change in vision. Medical insurances are used if the patient has a health concern such as sudden vision loss, visual field loss, dry eye, allergies, pink eye or is on high risk medications.
Hope this helped clarify some of the confusion.