Insurance & Your Visit to The Eye Center
Insurance, in the context of coverage for services provided by your optometric physician, is often confusing for many patients. Your eye doctor (optometric physician and/or ophthalmologist) is really the only health care provider whose services may be covered under two different types of insurance.
It is important to understand that when you have a VISION BENEFIT PLAN
and/or MAJOR MEDICAL INSURANCE
; coverage for all, or a portion, of fees for your visit is NOT guaranteed.
Payment is expected at the time a service is provided here at The Eye Center. If you have appropriate documentation of vision benefits or major medical coverage (i.e. “insurance cards”), then our staff will be happy to submit a claim to the appropriate carrier on your behalf. Co-pays and unmet deductibles must be paid at the time of service.
Almost all patients visiting The Eye Center will have to pay something during their visit. Usually this is in the form of a co-pay or unmet deductible.
- A co-pay is an amount of money, usually between $20 and $35, paid by patients as their share for the services provided. This amount is determined by your Plan, NOT The Eye Center.
- Deductibles are pre-determined amounts that must be paid by the patient for services on an annual basis. These amounts are typically between $250 and $500, and are also determined by the Plan, NOT The Eye Center. It is rare that our services would deplete all of your deductible in any calendar year. It is possible that a portion of a claim filed will be accounted toward the deductible, however.
NOTE: The Eye Center is contractually obligated to collect all co-pays and deductibles from patients according to the regulations of various Plans.
The optometric physicians at The Eye Center are participants in MOST vision benefit and major medical plans in the Mid-South. Most patients will have some portion, or even all, of the fees for services covered by one or more of their Plans. Each patient’s coverage is different, and each plan may have different versions.
We can only know for sure what YOUR vision benefit or major medical will cover by using the unique identification numbers provided to you by your Plan. This is best accomplished by submitting appropriate information to us in advance of your visit through our website, or by contacting one of our Patient Accounts Representatives via telephone at 901-722-3250.
It is important that you bring all insurance cards with you to every visit you may have at The Eye Center. This is particularly important as we are often unsure of which of your Plans may be responsible for covering a visit until we know the nature of your problem and reason for your visit. This point cannot be stressed enough. At times, patients think that their vision benefit plan is going to be responsible for their visit to The Eye Center. When they are examined, it is sometimes determined that an eye health issue is the cause of their problem, and therefore it is our obligation to file a claim with major medical insurance and NOT a vision benefit plan. The reverse of this situation can also occur!
Understanding Types Of Insurance Coverage.
The following information is designed to help you understand the special nature of insurance coverage as it relates to visits to The Eye Center. Examples of some of the more than 300 insurance plans we accept are included as well.
Vision Benefit Plans are used for wellness or “routine” eye health and vision care and is offered to some patients through an employer. Typically these plans cover comprehensive examinations and something toward materials (i.e. frames, lenses and/or contact lenses) every one or two years for enrollees. Examples of companies that provide vision benefits include: Vision Service Plan (VSP), Spectera, EyeMed Vision, and Davis Vision, to name a few.
Major Medical Insurance is the same insurance used at your primary care physician’s office and is used exclusively for visits related to eye health concerns (i.e. cataracts, glaucoma, diabetic eye exams, eye infections, etc.). Examples of companies that provide major medical insurance include: Blue Cross/Blue Shield of Tennessee, United Health Care and Cigna, to name a few.
If you are a retiree and are over the age of 62, you may have MEDICARE or a MEDICARE ADVANTAGE PLAN as your major medical insurance. Each of these government funded insurance plans cover visits related to eye health concerns as any other major medical insurance, but may also cover materials in very specific circumstances (i.e. glasses following cataract surgery).
Many major medical insurance plans offer a Medicare Advantage product for individuals eligible for traditional Medicare benefits. Examples of Medicare Advantage Plans include: Windsor Advantage and Health Spring Senior Care. It is important to remember that you may have major medical insurance through a particular company but NOT a Medicare Advantage Product.
MEDICAID and TENNCARE are also major medical insurance providers. These plans may be funded by the state of Tennessee, and provide coverage for some visits for eye health issues. If you are under 21, these plans may also cover some of the cost of materials when necessary. Examples of TennCare plans common in West Tennessee include: United Health Care Community Plan, BlueCare and TennCare Select.
The Eye Center participates in more than 300 different vision benefit and major medical insurance plans. It would be difficult to list each of the many plans accepted by The Eye Center and various options available depending on employer and/or patient preference.
To learn if we participate in the vision insurance and/or major medical insurance you have, contact one of our Patient Accounts Representatives or Case Managers by calling 901-722-3250.