Questions about insurance coverage are easily one of the most common things that my staff and I handle every day. In the past several articles, I’ve written about the more common questions that I, as an optometrist in Elyria, hear from my patients. I have written about all sorts of eye diseases and disorders, as well as the options for managing them. But the other day, I saw a patient that showed me the importance of talking about insurance.

I had seen her last year, and during the course of that visit I had found a moderate amount of bleeding in her retina. This was a result of diabetes. At that time, the bleeding wasn’t bad enough to affect her vision, nor was it bad enough to need any type of treatment. The appropriate thing to do was to watch it closely. I explained my findings to her and instructed her to return in four months to monitor her problem. Now, a whole year later, she returns for an exam. This time, the bleeding and her vision had gotten worse – a lot worse. She now needed a significant amount laser surgery, and she needed it soon. I asked her why she hadn’t come in for her exam eight months ago as I recommended, and she said, “…because my insurance only covers an exam once a year.” This is where she was wrong.

Medical Insurance can be used to see an eye doctor if you have a medical eye problem. Yes, I’m talking about the same insurance that you use to see your family doctor, heart doctor, surgeon and the rest. This insurance is for medical problems, including those of your eyes. Your eye doctor will bill your medical insurance for things like, ‘red eyes’, cataracts, glaucoma, eye pain, high blood pressure, and…you guessed it…diabetes. Your medical insurance will pay for as many visits as it takes to treat your problem correctly. If three visits to your eye doctor in the same month are necessary to treat an eye infection – your insurance will cover them just the same as if it took three visits in one month for your regular doctor to treat your bronchitis.

Many people confuse this with Vision Insurance. Vision insurance is what many people use on a regular basis (every one or two years) to get evaluated for glasses or contact lenses and for routine eye health examinations. This type of insurance will not cover the cost of caring for eye diseases, and is used periodically as the insurance company states. This type of insurance, vision insurance, is what my diabetic patient was thinking of when she said she could be seen only once a year. At the time, she didn’t know that her medical insurance would cover the visit that I had recommended for her.

So remember, health insurance is there to protect your overall health, whether it’s eye health or elsewhere. Insurance forms and rules can be confusing – but if it’s a health problem you have, then your health insurance likely covers it.