Medical vs Vision

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Medical insurance covers diagnosis and treatment of eye disease or injury (red eye, infections, glaucoma, diabetic eye disease, sudden vision changes) and medically necessary tests or procedures. Vision insurance pays for routine eye care aimed at maintaining vision—annual eye exams, refraction for glasses, and discounts on frames and contact lenses.

Which gets billed depends on the reason for the visit and the services provided: if your exam addresses medical symptoms or monitoring of an eye condition, it’s typically billed to medical insurance; a routine glasses/contact lens exam is usually billed to vision insurance. Sometimes an exam includes both routine and medical elements—your practice may split charges or bill the appropriate insurer based on diagnosis codes and payer rules.

Practical notes: co-pays, deductibles, and coverage limits differ between plans; prior authorization may be required for some medical tests; in-network vs out-of-network status affects patient cost.  Please bring both your medical and vision insurance cards to your appointment so we can accurately bill the correct plan and minimize unexpected charges.