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Billing FAQ

We understand that medical insurance, vision discount plans, and coordinatd billing are very complicated. We do our best to explain the process as best as possible; however, ultimately it is the patient's responsibility to understand their own insurance situation.
We have put together a list of the most-commonly asked questions regarding medical insurances, vision discount plans, and coordinated billing.
Do you accept my Vision discount plan?
Our offices will file your examination on your behalf for VSP, EyeMed, and currently Spectera. If you have a vision discount plan outside of these 3, then you will need to pay for your exam upon completion, then file your own paperwork for reimbursement using this page: reimbursement forms
Why do you need my medical insurance cards?
All eye doctors are liable for your ocular health and vision and thus are required to provide an comprehensive examination. If either one of your complaints is medical in nature (blurriness from a cataract, painful eye, eyelid bump you would like to be evaluated, headaches, new floaters, etc) or if there is a medical finding during the course of a "routine" examination that must be handled that day (retinal tear, bleeding, etc) then your exam's primary assessment will be medical in nature and thus can only be billed to your medical insurance. Asking your doctor our our billing team to 'miscode' your examination to lower your financial responsibility is asking us to commit insurance fraud.
Why was my examination billed to my medical insurance?
If either one of your complaints is medical in nature (blurriness from a cataract, painful eye, eyelid bump you would like to be evaluated, headaches, new floaters, etc) or if there is a medical finding during the course of a "routine" examination that must be handled that day (retinal tear, bleeding, etc) then your exam's primary assessment will be medical in nature and thus can only be billed to your medical insurance. Also, if a medical finding is causing your chief complaint (such a a cataract or repiretinal membrane causing your blurry vision), then this will rsult in a primary medical code. Asking your doctor our our billing team to 'miscode' your examination to lower your financial responsibility is asking us to commit insurance fraud.

Examples of medical diagnoses (not an exhaustive list):

  • Visually significant cataracts
  • Diabetics requiring retinal examination and report
  • Retinal anomaly such as a detachment, tear, membrane, bleeding, atrophy, etc
  • Macular degeneration
  • Visual Field loss
  • Abnormal finding requiring referral to a specialist
  • Swollen or bleeding optic nerve head
  • Requesting evaluation of a bump or lesion on the eye or adnexa
  • Stye or preseptal cellulitis
  • etc, etc, etc. There are many!
Can I visit your office if you do not take my insurance?
Yes! You will be considered "out of network" and you must pay your bill when the examination is completed. You may then submit your rceipt to your insurance for reimbursement. Please use this page as a starting point; otherwise you can usually Google and find your insurance's reimbursement form online: reimbursement forms
What is Coordination of Benefits or "COB"?

We see many patients who require medical examinations but who also may have a vision discount plan. In these cases, we try to use what is called "Coordination of Benefits" or COB. COB is when an examinaton is initially billed to the medical insurance and whatever they do not pay for (refraction usually), is then sent to your vision discount plan.

Now, this is when it gets tricky: if your vision discount plan does not paerticipate with COB, then that part of the bill will passed onto the patient. If you have such a plan, then we suggest finding a vision discount plan that participates with COB such as VSP (most plans - ask before purchasing).

If you know you have a medical concern or known medical problem, you can request to have your examination split up into 2 visits, but this may overall be more costly as well as time consuming.

To see how this process works, we have made a visual algorithm if it helps which is below...

Billing algorithm if you have both vision and medical insurance

Vision vs Medical

We understand that the differences between vision discount plans and medical insurance can be confusing. While "eye" insurance isn't an official term, it's important to know that a vision discount plan usually covers routine eye exams and eyewear discounts, but not medical eye care services. Medical insurance, on the other hand, covers medical treatments related to eye health. Knowing what each plan covers and how they are billed can help you make the most of your benefits. We're here to assist if you have any questions.

You have options

If you know you have a medical concern or known medical problem, you can request to have your examination split up into 2 visits. The first visit will address your medical concern and be billed to your medical insurance. This is to ensure your eyes are healthy enough to refract for a clear and stable prescription. If you would rather not do this, then you may be eligible to have everything done in 1 visit using Coordination of Benefits (if your vision discount plan participates).

Still have questions?

If your question is not answered here, please call 804-595-2020, option 4 to speak to a billing specialist about your concern.

If you think you need a 3-way call with us and your insurance provider, you must make that request with them - it cannot come from us. Please notify our office that you would like to request a 3-way phone call with your insurance company, then coordinate a time for all 3 parties to go over the concern.