Vision insurance is not the same as medical insurance. Medical insurance plans protect you and your family against eye diseases or unexpected injuries to the eye. Vision insurance, on the other hand, is designed to provide a routine health check of the eye, prescription eyeglasses, and other vision-related services at reduced prices.
What to Say When You Call Your Insurance Company
When you call your insurance company it is important that you ask the right questions because vision therapy is a specialty service.
Occasionally, we have run into situations where the insurance verification representatives will tell you vision therapy is covered yet the claim is denied when it is sent into the insurance company. Therefore, it is very important that you document who you speak with and the answers they give you. If you can get them to send you something in writing, (or fax something to our office), this would be even better. Please keep in mind it may take many months to get an answer and even then we have no way of ensuring that they will honor their statements to you even when it is in writing.
Asking specific questions, and using their language, helps eliminate some confusion. Insurance works with codes. The testing codes for the treatment the doctor is prescribing is:
- 96111 Developmental Testing
- 92060 Sensorimotor Exam
- 92065 Orthoptic Training
- 92270 Electro-Oculography
- 98902 Doctor/Parent Consultation
- 99204/99214 Evaluation/Management
Please read over these questions before you call.
- I would like to verify benefits for my son/daughter. Do you cover procedure code 92065, 96111, 92060, 92270, 98902, or 99204/99214?
- Is this code covered for the following diagnosis? (Then give them your specific diagnosis code.)
- Are there any restrictions or limits to the number of visits I may have in a day, week, or calendar year? Is there an age restriction?
- Is there exclusion on my policy for this procedure?
In general insurance clerks are helpful and more than willing to get you the information you need. Don’t be afraid to ask questions if you don’t understand the answer you have been given.
Please let us know if you have any questions.