Ophthalmology and Optometry Coding Alert

Question: We've been having problems with patients who tell us about their medical insurance but don't mention their vision plan until after they've picked out glasses, and often that creates a conflict because the doctor didn't know about the plan details when he prescribed a specific item, which sometimes ends up not being covered under their plan. Is there a solution for this?

Codify Subscriber

Answer: Vision plans typically cover either contacts or glasses every year, and it's up to you to know the patient's specific benefits up-front. When the patient calls your office for an appointment, ask about both their medical and vision plans, specifying the identification numbers so you can call to verify coverage before the patient presents for the visit.

Medical insurance does often have a benefit under certain plan provisions for routine vision care, which can cover the exam and refraction, and provide for a materials benefit as well. All of this is in addition to their vision plan benefits. If the patient also has a vision plan, find out what the coverage details are - but remember this distinction: Vision Plans are not insurance - they are a discounted fee for service plan that provides for an exam/refraction and materials or contact lens benefit. Typically it is a one-time per year benefit.