We hear this question many times per week when potential new patients call the office, or when local employers change their employees’ insurance benefits. There are two types of plans that we deal with in my office; “Routine Vision Care Plans” such as Vision Service Plan and EyeMed and “Major Medical Plans” such as Medicare, UMR, United Health Care etc. Let me explain how the two are different, and how they sometimes overlap a bit.
A Routine Vision Care Plan provides pre-paid and/or discounted fees for routine eye examinations, contact lenses and eye wear. These plans don’t cover medical eye care services such as treating an eye infectoin.
A Major Medical Insurance Plan covers medical eye care such as treating an eye infection, or diagnosing, treating and monitoring Glaucoma. Some major medical plans do provide a “wellness eye exam benefit” similar to providing a routine physical every year or two. We are “in network” or “panel providers” for the vast majority of the major medical plans in our area. There are some of these plans that are “closed panel” meaning that they aren’t accepting new providers, but most will allow providers to join their panel as long as the provider is willing to accept their fee schedule for payment for services.
There are several “Routine Vision Care Plans” that are active in our area. We are in network providers for two of them, Vision Service Plan (VSP for short) and EyeMed. These are the only two of these type of plans that to date are reasonable to administer and with acceptable reimbursement for services and eye wear/contact lenses. Two other plans, Spectera and Davis Vision are either too cumbersome to administer or don’t provide adequate payment for services and materials.
Insurance companies such as United Health Care have hundreds of different plans and programs that a patient may be covered by. There is no way for an office to know which of these programs each patient has or whether we are considered in network or out of network for that program. The simplest way to find out if we are in network is to call your insurance company at the number on the back of the ID card. I wish that there were a simpler way for patients and my staff to know this, but there really is not.
If you would like my staff to investigate becoming network providers for any major medical or vision care plans, just give us a call or send us an email. To help local employers provide a vision care benefit to their employees, I have also set up a discount eye care program which provides employees and their families with a simple to understand and administer program. If you would like to learn more about this program, please email Erin at firstname.lastname@example.org for more information.
This complex question doesn’t have a simple or clear cut answer, but we do our best to work with our patients and potential new patients to simplify the process.