How fees work
Insurance we work with
A routine eye exam is billed to a vision plan. A visit for an eye problem, an eye disease check or a follow-up is billed to medical insurance. Many visits mix both, and the office explains which part goes where. Medicare does not cover routine eye exams or glasses, with a few exceptions.
Vision plans, for routine exams, glasses and contact lenses
Medical plans, for eye health visits and follow-ups
A membership here is not insurance; its term, how to cancel and the refund rule are on the plan sheet
If you pay yourself
Most members pay themselves, through a plan or a visit at a time. A plan lists what it includes. Lenses, frames, contact lenses, fitting visits and tests beyond the exam are billed separately, and the office gives you the amount in writing before you decide.
Receipts for reimbursement
Ask for an itemized receipt and send it to your plan. The plan decides what it reimburses.
An estimate in advance
If you pay without insurance, you have a right to a Good Faith Estimate: a written estimate of the expected charges before your visit. Ask when you book. If a bill is $400 or more above the estimate, you can dispute it.
Checking your benefits
Before your visit we check your benefits where we can and tell you what we find. Please confirm with your plan too, because the plan has the final say.
What the first visit includes
A first exam takes about an hour and covers your history, your prescription and a check of the health of your eyes. For a member it is part of the plan. Anything else is agreed in writing first.
Visit by visit
Which visit goes where
The usual pattern. Your plan decides what it pays, and we check before you come.
| Visit or product | Vision plan | Medical insurance | You pay |
|---|---|---|---|
| Routine yearly eye exam | Vision planUsually | Medical insuranceNot usually | You payA plan fee if you are a member, or a written estimate |
| Eye problem, eye disease or urgent visit | Vision planNo | Medical insuranceUsually | You payCopay or deductible |
| Glasses and contact lenses | Vision planOften, up to the eyewear benefit | Medical insuranceNo | You payAnything above the benefit |
| A follow-up for an eye condition | Vision planSometimes, for the routine part | Medical insuranceOften, as an eye health visit | You payCopay or deductible |
Your prescription is yours
Your prescription is yours. We give you a copy after your exam and fitting, and you can fill it anywhere.
Questions about a bill?
Call the office before your visit and we will go through it with you.