We want advanced medical eye care to be as accessible as possible. Eye Rx - Washington accepts a range of medical insurance plans and vision benefits, and our team can help you understand how your coverage applies to your visit.
How Insurance Works for Eye Care
Eye insurance can be confusing, especially when medical exams, vision benefits, and specialty services overlap. Our staff is here to help you sort out what’s covered, what isn’t, and what to expect before you arrive.
In general, medical insurance covers conditions related to disease or injury, while vision benefits are typically used for routine wellness exams and eyewear. Depending on your plan and the reason for your visit, we may bill one or both.
Medical vs. Routine Vision Coverage
The type of coverage used for your visit depends on why you’re being seen and what the eye doctor finds during your eye exam.
If your visit is focused on a medical concern, such as dry eye, diabetes, glaucoma, infection, or injury, your medical insurance is usually billed. If your visit is primarily to update glasses or contact lens prescriptions and check overall eye health with no medical diagnosis involved, your vision benefit may apply instead.
Sometimes, both types of coverage are involved over the course of your care. Our staff will do their best to explain how your visit is being billed and answer any questions you may have.
Copays, Deductibles & Out-of-Pocket Costs
The type of coverage used for your visit depends on why you’re being seen and what the eye doctor finds during your exam.
If your visit is focused on a medical concern, such as dry eye, diabetes, glaucoma, infection, or injury, your medical insurance is usually billed. If your visit is primarily to update glasses or contact lens prescriptions and check overall eye health with no medical diagnosis involved, your vision benefit may apply instead.
Sometimes, both types of coverage are involved over the course of your care. Our staff will do their best to explain how your visit is being billed and answer any questions you may have.
Self-Pay & Out-of-Network Visits
If you do not have insurance or if we are out-of-network with your plan, you can still be seen at Eye Rx - Washington. We offer self-pay options for eye exams and services, and we will provide an itemized receipt so you can submit it to your plan if it offers out-of-network reimbursement.
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) can often be used for eligible eye care expenses. Check with your benefits administrator for details about what your account covers.
Some specialty services, such as medically necessary contact lenses, specific imaging tests, or advanced dry eye treatments, may or may not be covered, depending on your diagnosis and plan. In some cases, prior authorization or additional documentation is required.
Our team will discuss any recommended tests or treatments with you, including whether they are likely to be covered and what costs you might expect.