Insurance Information

Insurance plans are incredibly confusing even for us!  Below are answers to some of the most common questions patients have about their insurances.  We hope this helps.  Please feel free to call us if you have any questions.

Medical Insurances we accept:

• Aetna
• United Healthcare
• Oxford Freedom/HMO Freedom (not Liberty)
• Empire Blue Cross Blue Shield
• Cigna

Vision Plans we accept:

• Eyemed
• Superior Vision

NOTE: If you have VSP (Vision Service Plan) , Dr. Dong is OUT OF NETWORK for VSP.   If you still wish to be seen by Dr. Dong, you can pay in full for your eye exam and we will provide you with a detailed invoice that you can use to submit to VSP to be reimbursed directly.  Please call VSP to be sure you have out of network benefits before making an appointment with us. 

When you schedule your appointment, we ask for both your medical and vision insurance information.  If they are plans we accept, we will contact your insurance carriers to determine your eligibility, benefits, and what your estimated out of pocket expenses will be.  If you are not covered for whatever reason, we will let you know.  Please understand that determining your insurance coverage takes time and often requires phone calls to the insurance carriers so you need to provide us with your insurance information prior to your visit.

Many people mistakenly believe that if they have insurance they do not have to pay anything out of pocket when they see their doctors.  If only that were true!  Most plans typically require you to pay either a small co-payment (typically from $10 to $50) for each visit or a co-insurance which is a percentage (usually 10-30%) of the total cost of the visit.

These days, more and more patients are covered by insurance plans that have deductibles.  A deductible is a dollar amount for out of pocket expenses that you have to pay first before your insurance will cover you.  If your plan has a deductible, we will check if your eye exam is subject to the deductible and if so, whether you have met your deductible for the year.  If your deductible has not been met, you will have to pay more out of pocket for your visit.  We will submit a claim to your insurance company for the costs of your visit to help reduce your deductible.

To complicate matters even more, some patients also have health savings accounts (HSA) and flexible spending accounts (FSA) with their insurance plans.  This is pre-tax money that you choose to set aside each year for out of pocket health care expenses and is often part of higher deductible insurance plans.  Expenses for eye exams, glasses and contact lenses can be submitted to your HSA or FSA accounts.  We will provide you with an itemized invoice.

Medical insurances such as Oxford or Aetna cover you when there is a medical issue with your eyes.  For example, symptoms such as floaters, red eyes, and eye pain would be covered by your medical insurance.  If you are diagnosed with an eye condition such as Glaucoma or Cataract, this would also be covered by your medical insurance.

Vision plans such as Eyemed and VSP are additional insurance plans that your employer may offer you.  Vision plans are for routine eye care when there are no medical issues that need to be addressed such as your annual exam for glasses and contacts.  These plans have coverage for the eye exam services (usually a co-pay or discounted fee) as well as a benefit for new glasses and/or contact lenses.

To make it even more confusing, some medical insurances also have a benefit for routine eye care built into their plans.  This vision benefit covers routine eye exams that are not medical in nature and may also have coverage for new glasses and/or contact lenses.

There are instances when something is discovered during a “routine” eye exam that requires either treatment or further testing.  For example, glaucoma and diabetic eye disease often have no symptoms and are detected during a routine exam.  These both require further testing and evaluation which vision plans will not cover.  This is an instance where your medical insurance would be used.

Another example is when a patient comes to us because they are not comfortable with their contact lenses and wish to try different lenses.  If the problem is truly due to the contact lens, then refitting the patient into a new lens should solve the problem and the visit will be covered under their vision plan.  However, if the reason for the discomfort is an underlying corneal problem, then treatment is needed and the medical insurance would be used.

Medical insurance covers medical issues.  Vision Plans are a wellness benefit and will cover routine “healthy” eye visits.  We do our best to use the appropriate insurance when needed and will do everything we can to minimize your out of pocket expenses.

Many insurances that are part of an HMO (health maintenance organization) and most student health plans require a referral from your primary care physician before you can have your eyes examined.  If you have one of these plans, you need to contact your physician’s office to issue you a referral.  If you wish, we can call your doctor’s office on your behalf.  Please let us know ahead of time as it can take a few days to attain the referral.  Referrals cannot be backdated and without it, we cannot file a claim with your insurance carrier for your eye exam.  In these instances, you will either have to reschedule your exam until the referral is issued or pay out of pocket for the visit.

Refraction is the testing we do to determine your best spectacle lens prescription.  We do this testing during every routine eye exam and at other times, when needed, if you are having symptoms of blurry vision.  Refraction is regarded by medical insurance carriers as a service separate from the eye exam and is billed separately.  It is rarely covered by Medicare.  Vision plans, such as Eyemed and VSP, which provide for routine eye exams includes the refraction as part of their plans.  Medical insurances which have a routine vision benefit built into their plan will also cover for the refraction.  If the refraction is done as a necessary part of the testing during a medical office visit, it will likely be covered by most commercial medical insurances.  We will do our best to prepare your claim so that refractive services are covered.  However, Medicare is the only insurance that typically does not cover refraction, so for Medicare patients, we may bill you for cost of the refraction.

You can still be examined at our office but you will have to pay us in full for the exam.  We will provide you with a detailed invoice that you can submit to your insurance carrier.  Some insurance plans will reimburse for out of network providers so it is possible you may get reimbursed for some of the costs of the eye exam.  We recommend that you contact your insurance carrier to find out if they will reimburse you if you go to a doctor who is not on your plan.  Your other option is to find another optometrist who is a provider on your plan.

We offer a wide range of eye exam services.  The fees for our most commonly used services are below.  Please call our office if you have any questions or are not sure what services you need.

Please note that Contact Lens Evaluations are not done without a full eye exam so the contact lens service fees listed below are in addition to the fee for the Comprehensive Eye Exam.

All Contact Lens Evaluations include the following: evaluation of your current lenses, adjustments and refit as needed, training if you are a first time lens wearer, trial lenses as available, and any necessary follow up care.

Comprehensive Eye Exam $150

• Full eye examination including an eyeglass prescription if needed
• Eye health evaluation to check for Glaucoma, Cataracts, Macular Degeneration, as well as other eye conditions.  Dilation of the eyes with drops to check the retina (inside lining of your eye) is part of your exam. If you cannot be dilated on the day of your visit, we can screen for retinal problems with the Optomap Retinal Scan.

Contact Lens Evaluation, Level 1 $70 additional (=$220)

• This is for simple prescriptions (soft contact lenses only, no astigmatism, no bifocal or monovision fits)

Contact Lens Evaluation, Level 2 $120 additional (=$270)

• This is for moderately complex prescriptions (soft and rigid gas permeable lenses, low to moderate amounts of astigmatism that need correction, some monovision/bifocal fits may fall into this category)

Contact Lens Evaluation, Level 3 $170 additional (=$320)

• This is for highly complex prescriptions (soft and rigid gas permeable lenses, complex monovision/ bifocal fits, custom non-standard amounts of astigmatism that need correction)

Emergency Office Visit $125

• Symptoms of red eye, pain, light sensitivity, mucous discharge, floaters, flashes, sudden blurring or loss of vision need immediate attention.  Please call our office and you will be seen as soon as possible the same day.

We also provide Specialty Contact Lens services for patients who have certain corneal conditions such as Keratoconus, Pellucid Marginal Degeneration, post LASIK ectasia, post Radial K and other post surgical corneas.  These are patients who often cannot achieve acceptable vision and comfort with traditional contact lenses.  Some of these specialty contact lenses can also be used to treat patients with severe dry eyes.  The fees for these services are determined on a case by case basis.  Please call our office to speak with Dr. Dong