FAQ: Medical Insurance vs. Vision Insurance

​Why does Morris Eye Group ask for my Medical insurance? 
Morris Eye Group is a medical practice specializing in ophthalmology that diagnoses and treats medical conditions associated with the eye. Medical insurance generally covers eye care in relation to a medical condition. For example, if you need an eye exam because of cataracts, dry eyes, complications from diabetes, or in relation to diagnosed high blood pressure, then your medical insurance will provide coverage with ophthalmologist/optometrist. Medicare and other Medical Insurance Plans do cover the portion of the eye examination devoted to the determination of eye disease and the treatment of that disease.  Medical plans also cover diagnostic testing to aid the doctor in diagnosing eye disease and monitoring its progress.  If you have diagnostic testing performed, charges for these services will be billed to your medical insurance carrier.  You will be responsible for any copays, coinsurance and medical deductibles associated with your specific insurance plans. Vision insurance covers the vision screening, a refraction which is the test performed to obtain a glasses prescription, including dilation, and benefits towards glasses/ contact lenses. Vision Insurance rarely covers diagnostic testing to diagnose eye disease or monitor its progress.  If you need those services, their charges will be applied to your medical insurance plan, and any deductibles of coinsurance requirements of your medical insurance plan will apply.  Vision Insurance typically covers an eye exam once every 12-24 months, depending on the plan. Medical Insurance can be used as frequently as the doctor deems necessary for monitoring any ocular Medical diagnosis. 
 
Why doesn’t my health insurance cover my eye glass prescription? 
Although eye refractions are an integral part of a comprehensive eye examination, they are specifically excluded from coverage by Medicare and most Medical Insurance Plans (HMO’s and PPO’s).  Refractions are considered routine eye examinations for prescriptions for eyeglasses or contact lenses. Please see the CMS Publication “Your Medicare Benefits”. 
https://www.medicare.gov/coverage/eye-exams-routine 
  
Why are diagnostic pictures of my eyes not covered under my vision insurance? 
Vision insurance covers a once a year eye exam which includes; vision screening, a refraction which is the test performed to obtain a glasses prescription, dilation, and benefits towards glasses/ contact lenses. Think of this similar to benefits for an X-ray; photos are a diagnostic tool to assist the doctor in the treatment of eye conditions.  If a patient has a medical condition and we take a photo, it is billed to their medical insurance.  
  
Do we accept all HMO plans? 
No. If you have an HMO you are assigned a medical group. A medical group determines which doctors you can see that are contracted with your particular health plan. We are only contracted with certain medical groups which is why we do not take all HMO plans. If you are unsure which medical group you are assigned to, we recommend calling your primary care provider. Here is a list of the medical groups we are contracted with: 
·         Optum Care Network (OCN), previously known as Primary Care Associates (PCA) 
·         Greater Tri-City  
·         Scripps Coastal 
·         Graybill 
·         Perlman 
I have Medicare; why don’t they cover me 100% for my exam? 
Medicare has an annual deductible that must be met.  Once that deductible is met, Medicare will cover the patient at 80% leaving a 20% responsibility for the patient.  There are supplemental plans to Medicare that one can purchase to cover the portion that Medicare doesn’t cover. 
  
What’s the difference between Morris Eye Group and a Big Box Eye Care Center? 
Big box eye care centers only provide vision exams.  Morris Eye Group is a full-service medical practice that provides medical diagnosis, treatment and surgical services including; cataract surgery, LASIK, glaucoma management and treatment, and corneal treatments.  In addition to medical services, we have the largest optical dispensary in North County San Diego providing our patients with quality glasses and contact lenses. When a patient chooses to get full eye care with us, from start to finish, we have the ability to titrate any issues that arise after glasses have been dispensed because we monitor and control the process. If a patient elects to purchase eyewear elsewhere we have don’t have control on; materials/brand used, coding used, or how qualified the optician taking measurements. At Morris Eye Group, we use quality brands for our lenses and have access to choices for higher prescriptions, prism, and other brands should what we selected not work for the patient. Most of our opticians are licensed and certified and have a combined experience in optics of over 50 years.