​Optometry Billing and Coding- Is there a difference between medical insurance and vision insurance? There can be, and it can be extremely complicated and very confusing. Optometry billing can be different than other medical billing. Vision care can be covered by regular medical insurance plans or by plans exclusively for vision care. Because it is illegal to bill both the medical insurance payor and the vision insurance payor for the same service provided to a patient, patients and providers need to be clear on the differences between both kinds of insurance. The provider usually chooses the insurance plan to bill based on the main complaint of the patient. But determining which to select isn’t always so straightforward. 

Vision insurance is billed for most routine eye examinations, while medical insurance is billed for care for patients with medical symptoms and/or continued care for medical conditions. Further, there is a difference between the number of times that each type of coverage can be used annually. Most vision insurance plans only can be used once per calendar year, unlike medical insurance which can be used more often since medical issues and illnesses can occur more often.

Sifting through the details of each is key. One detail to consider is the difference between types of eye exams. The type of eye exam provided is determined by the reason for the visit or the chief complaint, or the specific diagnosis of some eye condition; most insurance companies focus on this. Insurance companies sometimes manage routine vision exams differently than eye exams carried out due to a medical reason. Medical insurance may cover eye issues resulting from a medical circumstance, but not pay for exams provided for routine eye care. Many vision insurance plans provide full or partial coverage for glasses and/or contact lenses that medical insurance does not cover.

Differentiating between medical and vision insurance can be tricky or confusing for patients and providers alike, especially since vision insurance is often offered as a supplement to regular medical health insurance plans, rather than separately. If someone has both medical insurance and vision insurance, it’s important to have a good understanding of what each plan covers and under what circumstances. Making sure there is awareness of and familiarity with the way insurance companies handle routine eye exams versus medical eye exams is essential; studying policies closely is important because plan coverage can vary so much. Knowing the basics of both your medical insurance options and vision insurance options can help guide you as you ask questions of the practitioners you see. Because optometry care and medical care can have significant differences, it is important to complete an analysis of which insurance coverage is best to meet patient needs.

Outsourcing billing to a professional coding and billing company like Quick Claimers Medical Billing may be the best solution for your vision care practice. The experts at the El Paso, Texas-based Quick Claimers office are available to answer your questions as a care provider. To learn more, contact the skilled medical coding and billing team online or by phone at 915-351-6600. Consider Quick Claimers Medical Billing for all your medical coding and billing needs.

Written by: Erika Mehlhaff