Question: What do you do when patients expect their visits to be covered under their vision benefit plans, but their complaints are medical and should be billed as such?
This is the No. 1 question that I receive as the Business & Career Coach for AOAExcel. Transitioning to the medical model requires changing the mindset of both staff and patients. Below is a sample one-page handout to educate staff and patients on the differences.
What is the difference between routine vision benefits & medical eye insurance?
Vision benefit plan (example plans are VSP, Eyemed, Superior)
Routine exams that update prescriptions for glasses or contact lenses and assess the overall health of the eye are filed under vision benefit plans. During that exam, if eye health problems are discovered a follow-up exam will be scheduled. That visit will be billed to your medical insurance.
Medical insurance (example plans are Medicare, Blue Cross/Blue Shield, Coventry, Aetna)
An office visit for conditions such as glaucoma, diabetes, macular degeneration, and dry eye are filed under medical insurance. Most complaints of pain, redness, swelling, itching, and loss of vision are related to eye health and would most likely be diagnosed as medical. If you have a systemic disease that has eye complications, this would also be considered a medical eye encounter and would be filed toward your medical insurance.
In the past our office has used your vision benefit for both routine and medical eye at your yearly exam. Due to the ever-changing landscape of health care we will now be billing your vision benefit and/or your medical insurance. In some instances, the services are split and billed to both your vision benefit plan and medical insurance. This will be determined based on the reason you are in the clinic to see the doctor. We are committed to working for our patients and will continue to assist you through these changes. Thank you for your understanding.
