Vision vs Medical Insurance

What is the difference between Vision Plans vs. Medical Insurance?

At ECVA we offer comprehensive vision and medical examinations. How ECVA submits a claim for your visit depends on which provider you see.

If your appointment is with one of our Optometrists (OD) for a routine or annual vision exam, ECVA will submit a claim to your vision plan. Note, that your medical insurance may contain a vision “rider.”

If your appointment is with one of our Ophthalmologists (MD) ECVA will submit a claim to your medical insurance or health plan.

If you request ONLY a routine or annual vision exam, your appointment will be scheduled or rescheduled with one of our Optometrists (OD). If during the course of the vision exam, a medical condition is found, your next appointment will be scheduled with an Ophthalmologist (MD).

The Optometrist (OD) will perform your “routine” or annual vision exam. If you have trouble with your vision (nearsighted, farsighted, astigmatism, etc.), your visit is considered a vision problem and will be billed to your vision plan. Vision plans may provide coverage or discounts for routine exams, glasses, and contact lenses. It is important that you understand that your Vision Plan benefits.

The Ophthalmologist (MD) is a medical doctor and provides services beyond a typical “routine” or annual eye exam. Examples of medical issues are:

Irritation or gritty
Styes
Headaches
Macular degeneration
Light sensitivity
Allergies
Infection
Corneal disorders
Diabetes
Lazy eye
Cataracts
Glaucoma or glaucoma suspect
Dry eye
Double vision
Trauma or injury
High-risk medicine such as plaquenil

If you have or have had a medical issue and you see the Ophthalmologist (MD), your visit will be billed to your medical insurance. It is important that you understand that when your visit is with the Ophthalmologist (MD) and is done in conjunction with a routine or annual eye exam, ECVA will send a claim to your medical insurance. As such, your financial responsibility will be determined by your medical insurance policy.

Note, even if your visit is billed to your medical insurance, you can still use your vision plan benefits or discounts, if any, to acquire glasses or contact lenses from our Optical Shop!

Refraction policy

A refraction is a test done to determine the best-corrected vision for your glasses prescription. Refraction must be performed if you wish to get a new or updated prescription for glasses.

Medicare and some other major insurance companies consider refraction to be a non-covered service, and require us to bill the patient for it. There is a fee for this service. The refraction fee will be collected in addition to any co-insurance, copayment, or deductible required by your insurance plan.

Optical insurance coverage

ECVA optical shops participate in numerous vision plans including Eyemed, VSP, Fidelis and Your Care. Our licensed opticians are available to assist you in achieving the maximum value from your vision coverage or benefit.

With which Vision Plans does ECVA participate?

VSP
EyeMed
Davis Vision – through Fidelis insurance only

At this time, our optical shops do not participate in the following vision plans:

United Healthcare
Davis (other than through Fidelis)

With which Medical Insurance plans does ECVA participate?

Medical insurance must be used if your appointment is with an Ophthalmologist (MD) or Optometrist (OD) and you have or have had an eye health problem or a systemic health problem that has ocular complications (e.g., diabetes).