Contracted Insurances

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Medical insurance covers visits related to a medical diagnosis:

MEDICAL Diagnoses: 

• Blepharitis (inflammation of the eyelids) 
• Cataract (thickening of the natural lens) 
• Conjunctivitis (inflammation of the conjunctiva)
• Drusen  (deposits in the retina) 
• Dry Eye (physical and visual discomfort) 
• Glaucoma (damage to the optic nerve) 
• Macular Degeneration (damage to the retina) 
• And others 

Symptoms:

• Redness
• Dryness
• Pain
• Foreign body sensation
• Itching
• Flashes
• Floaters
• Double vision
• Sudden loss of vision
• Headache
• And others
  

Medical insurance covers the exam and diagnostic tests like visual field, nerve scan, retina scan, etc.  

Vision insurance covers a routine eye exam.

VISION Diagnoses: 

• Hyperopia (farsightedness) 
• Myopia (nearsightedness) 
• Astigmatism (abnormal curvature of the cornea) 
• Presbyopia  (inability to read up close over time) 

Vision insurance covers the procedure to measure a glasses prescription (refraction) and may also pay for a portion of your actual hardware like lenses, frames, and contact lenses. 

Because the need for glasses is not the result of illness or injury, Medicare and many other insurance companies do not consider this test “medically necessary” and therefore don’t cover this part of the exam under medical insurance.  

What does that mean?

• A refraction (glasses prescription) treats a vision diagnosis according to insurance companies.

• Medical insurance covers medical conditions and medical treatments.  

• Needing glasses is not considered a medical condition to insurance companies.  
   
• A refraction (glasses prescription) is not covered by medical insurance because it treats a vision issue, not a medical issue, in the eyes of medical insurance companies. 

Because a refraction is not covered by any medical insurance, all glasses prescriptions dispensed have an out-of-pocket cost.

 Swedberg Eye Care is not in-network with ANY vision plan: 

This means we are not contracted with: 

• VSP 
• Eyemed 
• Spectera 
• Premera Vision 
• Regence Vision 
• Aetna Vision 
• Cigna Vision 
• Or any other provider of vision insurance

This means that we are out-of-network and do not have the permission to bill your vision plan. 

If you have a vision plan, you may have the option to pay for the refraction out-of-pocket and bill your insurance plan for reimbursement if you have out-of-network benefits.