Which Insurance do I use? Vision or Medical?
Your vision insurance will typically cover a routine exam once per year, and part or all of your purchase of glasses or contact lenses. Focusing issues of the eye including nearsightedness (myopia), farsightedness (hyperopia), astigmatism, etc. are considered routine and are covered by vision insurance, but not by medical insurance.
If your visit is to take care of a physical problem like a blocked tear duct, droopy eyelid, lazy eye, crossed or wandering eye, amblyopia, glaucoma, cataract, headache, etc., your visit will be medical and not covered by your vision insurance.
Learn more about the difference here.
A refraction is the determination of the need for glasses or contact lenses. It is an integral component of any complete eye exam but is identified as a separate service by your insurance company, both the medical and the vision types of insurance. Vision insurance covers the refraction charge, and some medical insurances may cover this charge, but many do not.
With any of your eye care needs, our staff will work with you to get you the best coverage for your situation. Whether the exam is routine (vision insurance) or medical (medical insurance) is determined by the doctor during your exam: if medical issues are discussed and addressed, the exam will be medical. If there are no medical issues, even if your primary care doctor referred you for evaluation, the exam must be billed routine (these are your insurance company rules, not ours).
Should you find your exam is not covered by your insurance, we offer a substantial cash discount for your exam. Many times, our front office staff can help you sort this out at the time of your appointment. If you receive a bill you don't believe you should have received, please call us at 425-823-EYES (3937) and we will do our best to help you sort out the situation!
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Don't worry! If you don't see your plan here, call us and we will verify your coverage.
Patients with United Healthcare:
Children's Eye Care and all of our providers are currently out of network.
United Healthcare has not approved our credentialing process. We initiated this process in the fall of 2024 but, unfortunately, multiple errors have occurred on their end, resulting in repeated delays in credentialing our doctors. Children's Eye Care and outside consultants have contacted United dozens of times over the last 8 months, receiving conflicting, inaccurate, or misleading direction on behalf of the company. Despite these issues, there has been no effort on their part to expedite this process.
We are currently aiming for a credentialing completion date of September 1st, which they have indicated as the expected timeline. We sincerely apologize for this delay, as it is impacting us as well.
WHAT CAN I DO?
If you have received a bill from us as "out of network":
We will work with you to discount the cost of this bill. Please call us at 425-823-3937 to discuss.
If you have an appointment coming up with us:
We will be calling to reschedule all appointments and surgeries until after September 1st. If you want to keep your current appointment or surgery, we will work with you to discount the cost if United refuses to cover your visit (which is likely).
If you would like to register a complaint with United over this issue and concern that it may affect the health of you or your child:
You may contact them via Chat on their website: www.uhc.com, or via the UHC App.
You may try calling them at one of the following numbers: 1-866-801-4409, 1-844-812-5967, or 1-866-487-9299. If you have a medicare advantage plan, use one of these numbers: 1-800-523-5800 or 1-877-916-2246.
We are very sorry to all our patients with United Healthcare. We understand how frustrating and difficult our healthcare system can be, and this only makes it worse. Please know we are also frustrated by their dysfunction as it significantly affects our small business and our ability to take good care of all of you.
Please call us if you'd like to discuss further.
Sincerely,
David Epley, MD and Vy Mai, OD
Owners, Children's Eye Care
Billing Information
Please call us directly with any billing issue first (425-823-3937).
It is our pleasure and our privilege to help you and your family with the care of their eyes. We work hard to make your visit a positive experience. We thank you for trusting us with the care of your eyes, or those of your child or children. We take this care seriously and are honored you have chosen us for this care.