Where can you use your vision insurance benefits?
Where you can use your vision insurance benefits depends on the specific provisions of your vision insurance or vision benefits plan.
Vision insurance, like medical insurance, often operates under rules and regulations that can be confusing. Before you schedule your eye exam, review your vision insurance policy, the benefits it provides, and what your financial responsibilities are.
The largest vision insurance plans in the United States are VSP Vision Care and EyeMed Vision Care. Mastering the ins and outs of your vision insurance benefits starts with obtaining a copy of your plan brochure, either online or from your insurer.
Carefully review the plan information, paying particular attention to what services are included, the costs involved, and who is on your network provider list.
If there is no network provider list, check with your insurer that you can choose any eye doctor near you.
Vision insurance questions to ask your eye doctor
When you’re ready to make an appointment, provide the practitioner’s office staff with the name of your vision insurance company, the plan under which you’re covered, and your ID number.
The office can then confirm that they accept your vision insurance, and they also have the information they need to obtain a pre-authorization from your vision insurance company (if one is required) before scheduling your appointment. If you must choose an eyecare professional from the insurer’s list — and your preferred provider is not on it — you can pick a new authorized provider or ask about the insurer’s policy regarding out-of-network providers.
For example, do they need the approval of the insurer so you can receive reimbursement? What reimbursement amounts can you be expected to receive for each product or service, and how do you request those reimbursements? It’s important to note that if you choose an eye doctor from outside the network, expect to pay the full retail price for the services you want at the time of service. Then you must submit a reimbursement request, including an itemized copy of all your receipts, to your vision insurance company to receive reimbursement.
When you might choose not to use vision insurance
After reviewing your particular situation and what your expectations are for your vision insurance coverage, there may be some circumstances under which you choose not to use your vision insurance benefits. These include:
When you want to stay with your current optometrist or ophthalmologist but he/she is not on your vision plan’s list of preferred providers.
The network provider is located farther away than you are willing to travel, or if you have difficulties setting up a convenient appointment within a reasonable amount of time.
If the selection of eyeglass frames, lenses, and contact lenses offered by the provider do not match your needs or tastes, or aren’t covered by the vision plan.
When you can buy the prescription eyeglasses and contact lenses that you need at a lower price by going outside the provider network to an online service.
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Page updated January 2021