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Understanding Your Costs and Coverage at Medical Eye Center

Woman smiling while considering eye care costs

At Medical Eye Center, we prioritize transparency, especially when it comes to the costs associated with routine vision exams, glasses, and contact lens coverage. Let’s dive into the details of our pricing structure, shedding light on the factors that contribute to the expectations of costs for our patients. Our commitment is to help you understand the financial aspects of your care and make the best choices for your eye health.

Routine Vision Exam:

At Medical Eye Center, we understand the significance of routine vision exams in maintaining optimal eye health. We have designed our pricing model for routine vision exams to be clear and straightforward. Patients can expect a comprehensive examination to assess their vision needs without the burden of deductibles.

Glasses and Contact Lens Coverage:

We believe that clear vision should be accessible to everyone. That’s why we accept many vision coverage plans for both glasses and contact lenses. Patients with standard contracted vision plans, including most VSP Visions Care plans, Medicaid Vision for children, and Superior Vision, can benefit from our services. However, it’s crucial to note the variations in coverage, such as plans requiring a same-day purchase of glasses to cover the exam. Typically the contact lens measurements and fit are a separate portion of an exam and would be a different cost depending on insurance coverage usually $65 for ad refit and $135 for a new fitting and Medical contact lenses such as specialty scleral fittings can range from $285-$1232.

Additional Measurements and Exams:

For patients requiring contact lenses, we go beyond the standard vision exam to include separate measurements/exams. This ensures that our patients receive personalized and accurate prescriptions tailored to their unique needs. The refraction or general exam charge is covered, providing a comprehensive approach to eye care.

VSP Vision Care Benefits:

Our association with VSP brings extra benefits to our patients. From a $10 Optos Discount to potential coverage of an entire Optos exam, for those of you that may not know an Optos Retinal exam is an in-depth ultra-wide scan of almost the entirety of the eye, that can help detect early signs of disease and retinal damage. Where traditional scans can see just a portion of the eye the Optos Retinal Scan can see a wider range of the back of the eye improving this scan from just 15% to 82%. A standard out-of-pocket expense is usually $69, but VSP typically costs $60 out of pocket but may be covered entirely with not out-of-pocket costs, depending on your specific plan.Eye diagram
  
A patient that holds VSP coverage may expect to only pay their co-pay out of pocket which would vary depending on their coverage and if the VSP plan is one requiring a co-pay. VSP plans that allow coordination of benefits even provide payment on refraction for a medical exam if the medical plan denies coverage. A refraction test is usually given as part of a routine eye examination and is often referred to as called a vision test. This test tells your eye doctor exactly what prescription you need for your glasses or contact lenses. VSP also offers a robust coverage of medical scleral lenses if determined necessary by your provider. Some VSP plans cover the entire cost of scleral contact lenses fittings while others allow a 15-20% discount, while the patient pays the remainder.

Refraction Charges and Insurance Coverage Differences

While a refraction is essential for a comprehensive eye exam, the charge for a refraction is only covered by some insurances but not all. Medicare does not cover refractions because the test is considered to be a part of a routine exam and not a medical need. Traditional Medicare does not cover most routine procedures, but rather health-related vision expenses, although in 2024 coverage for Medicare Advantage has changed and may have more benefits, and it’s important to know whether you have one version or the other. At Medical Eye Center, a standard refraction or eye exam may cost $60 if no other insurance benefits can be applied. VSP benefits will also provide a 15% discount on LASIK surgery, which is deemed an elective procedure and not typically covered by insurance benefits. This allows the cost for LASIK surgery to drop from $5500 to just $4675 for VSP covered patients.

If not going the LASIK route and sticking with contacts, VSP coverage allows for patients with astigmatism who need a corneal scleral lens and significant benefit of coverage on $1000 for a contact lens fitting and exam and often hundreds towards the lenses themselves.

Non-Contracted Plans:

While we have affiliations with various vision plans, we must note the plans we are not contracted with, including Spectera Vision, Davis Vision, Jackson Care Connect, EyeMed, and Medicare DMERC for post-op glasses. However, patients with these plans may still enjoy a 20% discount on most optical purchases if they decide to buy from Medical Eye Center. If you have non-contracted insurance providers, you may be able to submit paperwork independently as a patient and get reimbursed for your optical purchases. It’s worth checking with your insurance company to see if this is an option for you

Exceptions to coverage:

Medical Eye Center accepts most major medical plans, and we understand the nuances of deductibles, copays, and coinsurance. At the same time, many medical plans cover some or all of the refraction charge, exceptions exist, such as Regence BCBS Commercial plan, Wellcare MedAdvantage, and certain Medicare plans as mentioned earlier. Additionally, a few other plans that often do not cover refractions are HealthNet of OR, Blue Cross Government, Anthem, MODA Advantage, and PacificSource Medicare. When used as secondary insurance or Tricare For Life and some other plans, the Oregon Health Plan covers refraction costs or a portion of it.

Addressing Plan Denials:

When a patient’s plan denies coverage for the refraction charge, we offer a $9 discount, ensuring that our patients receive fair and transparent pricing. Our commitment to transparency extends to our interaction with Veteran PGBA contracted providers.

At Medical Eye Center, we believe transparent pricing is fundamental to building trust and ensuring our patients understand their financial responsibilities. By providing detailed information about our pricing structure, we empower our patients to make informed decisions about their eye care, fostering a positive and open healthcare experience. “If you ever have any confusion regarding what expenses are covered and what are not during your visit, feel free to ask our staff without any hesitation.

Sources:
https://www.sightmd.com/blog/what-is-a-refraction-and-why-doesnt-insurance-always-cover-it/
https://www.oregon.gov/oha/PEBB/Documents/02-PEBB-VSP-Summary.pdf
https://www.nvisioncenters.com/insurance/vision-insurance-providers-oregon/

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