Billing FAQs

EyeCare Oklahoma, Inc
First Look Eyewear
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Billing FAQ

What is the difference between medical insurance and vision insurance?

Medical insurance applies to office visits that are evaluating or treating medical diagnoses such as cataracts, glaucoma or macular degeneration. It generally does not cover routine vision needs such as measurements for eyeglasses (refraction) or contact lens fittings.

Routine vision benefits generally cover a baseline eye health exam and the measurements for eyeglasses in addition to materials such as eyeglasses or contact lenses. These benefits do not cover comprehensive medical evaluations or testing related to medical diagnoses.


Why won’t my medical insurance cover my refraction charge?

The measurement for eyeglasses (refraction) is usually not covered by medical insurances because it is considered a routine vision benefit and is not related to the treatment of a medical diagnoses. Most medical insurances consider this an out-of-pocket expense for the patient, unless they have routine vision benefits. Make sure you understand your insurance plan and how it covers refractions before your appointment.


Why did my diagnostic testing not fall under my exam copay since it was performed at the same visit?

Although diagnostic testing is often performed at the same visit as an exam, it is considered by medical insurances to be a separate benefit from the medical exam and may be subject to deductible or percentage copay, depending on a plan. Make sure you understand your insurance plan and how it covers testing before your appointment.

Medical insurance applies to office visits that are evaluating or treating medical diagnoses such as cataracts, glaucoma or macular degeneration. It generally does not cover routine vision needs such as measurements for eyeglasses (refraction) or contact lens fittings.

Routine vision benefits generally cover a baseline eye health exam and the measurements for eyeglasses in addition to materials such as eyeglasses or contact lenses. These benefits do not cover comprehensive medical evaluations or testing related to medical diagnoses.


Why do I have to pay another copay for a follow-up visit to examine the problem diagnosed at my original visit?

Your insurance company determines what constitutes a follow-up visit. In most cases, insurance does not consider any visit a follow-up “no-charge” visit to a previous visit unless you have had a recent surgery. Please allow our insurance department to verify your benefits and answer any questions you may have.


Why did my secondary insurance not cover my balance?

Secondary insurances are often subject to their own deductibles or a percentage copay before they will cover any services. Make sure you understand how your secondary insurance applies benefits before your appointment.


Why am I paying a specialist copay rather than a PCP copay?

Medical insurances consider ophthalmologists and optometrists to be specialty providers since they do not provide primary care, but focus only on eye care.


What’s the difference between an insurance denial and non-payment due to out-of-network?

An insurance denial on a service occurs because either the member did not have an active policy or the service was not covered under the insurance plan. An out-of-network non-payment occurs because the doctor was not contracted as in-network with a patient’s insurance, and the patient did not have an out-of-network policy. Eye Care Oklahoma makes every effort to verify insurance prior to an appointment, but it is ultimately a patient’s responsibility to know and understand their out-of-network benefits.


Why is my out-of-pocket expense different than originally quoted?

Eye Care Oklahoma’s verification of insurance benefits is only an estimate of possible out-of pocket expenses. Insurance companies do not guarantee payment when quoting benefits, so our information is simply an estimate, not an exact amount that will be due after services are rendered.