That’s a great question, I see many patients that want to come to our office but don’t have their vision benefit with us. That means in many cases that we are an out-of-network provider. Usually you can come to our office for vision care and receive a partial reimbursement from your vision plan. If we are not on your vision plan you can still submit your claim to your benefits department for a reimbursement to you from your plan. You would pay us for our exam services and materials. We will give you a superbill aka billing statement and codes which will allow your benefits department and vision care plan to determine how much they would reimburse you for our services. It is still advised that you check this out in advance of using our services.
Group vision insurance can be obtained through your company, association, school district, etc., or through a government program such as Medicare or Medicaid. Also, as an individual, you have the option of purchasing your own vision benefit plan.
Vision insurance is often a value-added benefit included in indemnity health insurance plans, health maintenance organization (HMO) plans and plans offered by preferred provider organizations (PPOs):
- Indemnity health insurance is traditional insurance, which allows policyholders to access medical providers of their choice.
- An HMO is a group of healthcare professionals – doctors, laboratories, hospitals and the like – employed to provide health care services to plan members at discounted rates. Usually, health plan members are required to access health care only from HMO providers.
- A PPO is a network of healthcare professionals organized to provide healthcare services to plan members at a fixed rate below “retail” prices. Plan members may opt to access out-of-network providers, but usually at a greater cost.