Eye Care: Billing and Insurance

 

Billing and insurance can be confusing. Here are a few tips to help you understand what may or may not be covered during your next Park Nicollet eye exam.

1. Contact your health insurance company before your visit.

  • Ask which services your insurance plan will cover.
  • Not sure who to call? A customer service number is usually found on the back of your insurance card.

2. Understand your eye care exam.

Your health insurance company will want to know if you are receiving routine eye care or medical eye care. What's the difference?

Routine eye care

  • Routine eye care is for nearsightedness, farsightedness and normal astigmatism.
  • Most health insurance plans will cover some part of routine eye exams.
  • Your bill will depend on how much your health insurance plan covers.

Medical eye care

  • During your routine eye exam, your doctor may find a medical eye condition that needs medical eye care. Medical eye care is for more complex eye conditions like:
    • Cataracts
    • Diabetic eye disease (retinopathy)
    • Dry eyes
    • Glaucoma
    • Hypertensive eye disease
    • Retinal holes or tears
  • Medical eye care can include follow-up care, regular monitoring, additional tests, referral to a surgeon and other services.
  • Most health insurance plans will cover some medical eye care.
  • Your bill will depend on how much your individual health insurance plan covers.

3. Do you have a separate vision insurance plan?

Vision Insurance is a benefit offered by some employers. Park Nicollet doesn't accept these plans:

  • Davis
  • EyeMed
  • Spectera
  • VSP

4. Be prepared. Before you arrive at your appointment:

  • Bring your insurance card(s) and ID with you to each appointment.
  • Understand your plan and insurance policy's specific rules regarding:
    • Approved providers
    • Authorizations
    • Covered services
    • Out-of-pocket payments
    • Referrals
  • Be aware that you may need to pay a copay at the time of your eye exams.
  • Remember, you may not know you have a medical eye condition until your eye doctor does a routine eye exam.