Alamo Optometry Blog

December 1, 2008

Insurance and Flexible Spending Accounts

Filed under: Educational — Tags: — admin @ 11:20 pm

(As appeared in Alamo Today Dec 2008 edition, pg.28)

People are often confused when it comes to insurance. Sometimes with your medical insurance comes a vision reimbursement plan; you are allowed a certain amount every year and you get reimbursed from your insurance company. However, most patients have separate medical and vision coverage. There are many companies offering vision insurance, the most common is Vision Service Plan (VSP). In addition, if you have Kaiser for your medical coverage, you might have VSP for vision coverage, so you can go to any private office for your eye care. The nice thing about vision insurance is that it tends to be simpler than medical insurance. No referrals are needed; regardless of what type of insurance you have from VSP to Medicare, you can visit the doctor of your choice with no prior authorization required.

Our office only directly bills VSP and Medicare; however, if you have another insurance, we are happy to have you as a patient. At the end of your visit, we will give you an itemized receipt to submit for possible reimbursement. As for VSP, annual exams are covered with a small office co-pay. In addition, an allowance and discounts for glasses or contact lenses are usually permitted annually, depending on the individual plan. With VSP, you use your benefits or you lose it, you can’t go back and utilize unused benefits from the past. Also, full VSP benefits can only be used at private offices, not at commercial stores like Costco and Lenscrafters, or online for contacts. If we are unable to help you find the glasses for you, we recommend at least you find an office where your benefits can be fully utilized.

As for Medicare, it will cover the medical portion of the exam, not the refraction (the determination of your eyeglass prescription). Medicare only has benefits for glasses after cataract surgery. If you have already met your annual deductible, Medicare will cover a good portion of the exam.

There are many instances where a medical eye problem would bring you to the office. When the visit involves a medical condition (red eye, infection, foreign body, allergies), a majority of the time the bill can be submitted to the medical plan for reimbursement. Since optometrists can treat most ocular medical conditions, patients can be seen at our office instead of going to their primary care doctor or emergency room. In addition, some VSP plans also contain a provision called Primary Eye Care, which covers medical visits for only a $5 co-pay. Since we have the necessary equipment and training to handle most eye conditions, you can feel comfortable using our office for your medical visits as well as for your annual exams.

Finally, it is that time of year where Flexible Spending Accounts (FSA) need to be used before the end of the calendar year, or the benefits will be lost. A FSA plan allows employees to take out money pre-tax to help pay for qualifying medical bills. These include doctor visits, office co-pays, prescription drugs, surgery, and dental bills. In addition, all glasses, sunglasses, and contact lenses are controlled by federal regulations and are considered medical devices. Any purchase of these materials can be used using your FSA. We will give you a detailed receipt for you to submit to your Human Resources Department for reimbursement.

It is our job to help explain your benefits to you and how to best utilize your coverage. If you have any questions regarding your insurance or FSA reimbursement, we would be more than happy to assist you.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo.

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